- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $144.54 / $223.87
| Facility | | $102.33 | $144.54 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $165.96 / $323.59
| Professional | | $107.15 | $165.96 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $158.49 / $239.88
| Professional | | $128.82 | $158.49 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $173.78 / $234.42
| Professional | | $112.20 | $173.78 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $123.03 / $251.19
| Facility | | $109.65 | $123.03 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Professional | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $190.55 / $190.55
| Facility | | $181.97 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $165.96 / $257.04
| Professional | | $114.82 | $165.96 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $102.33 / $138.04
| Facility | | $100.00 | $102.33 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $144.54 / $213.80
| Professional | | $107.15 | $144.54 | $213.80 |