- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $128.82 / $162.18
| Facility | | $123.03 | $128.82 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $239.88
| Professional | | $109.65 | $151.36 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $128.82 / $169.82
| Professional | | $102.33 | $128.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $194.98
| Professional | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $141.25 / $208.93
| Professional | | $70.79 | $141.25 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Facility | | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $234.42
| Professional | | $109.65 | $151.36 | $234.42 |