- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.07 / $118.07 / $119.18
| Facility | | $118.07 | $118.07 | $119.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.51 / $109.12 / $148.76
| Professional | | $95.51 | $109.12 | $148.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.08 / $107.27 / $107.27
| Professional | | $91.08 | $107.27 | $107.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.64 / $157.36 / $307.14
| Facility | | $84.64 | $157.36 | $307.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.49 / $165.23 / $196.70
| Professional | | $149.49 | $165.23 | $196.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.23 / $161.19 / $443.13
| Professional | | $103.23 | $161.19 | $443.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.04 / $104.04 / $119.18
| Facility | | $104.04 | $104.04 | $119.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.09 / $118.07 / $154.96
| Professional | | $100.09 | $118.07 | $154.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.15 / $101.76 / $147.35
| Professional | | $82.15 | $101.76 | $147.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.37 / $116.71 / $170.12
| Professional | | $102.37 | $116.71 | $170.12 |