- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.58 / $234.72 / $352.08
| Facility | | $125.58 | $234.72 | $352.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.91 / $141.80 / $280.02
| Professional | | $128.91 | $141.80 | $280.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.47 / $405.13 / $663.88
| Facility | | $101.47 | $405.13 | $663.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.51 / $112.74 / $746.54
| Professional | | $77.51 | $112.74 | $746.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.72 / $117.36 / $117.36
| Facility | | $110.72 | $117.36 | $117.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.36 / $117.36 / $117.36
| Professional | | $117.36 | $117.36 | $117.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.19 / $154.69 / $184.34
| Facility | | $117.19 | $154.69 | $184.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.19 / $117.19 / $117.19
| Professional | | $117.19 | $117.19 | $117.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.36 / $117.36 / $117.36
| Professional | | $117.36 | $117.36 | $117.36 |