- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.47 / $129.47 / $233.24
| Facility | | $129.47 | $129.47 | $233.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $129.47 / $156.79
| Professional | | $129.47 | $129.47 | $156.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.47 / $141.16 / $142.97
| Facility | | $140.47 | $141.16 | $142.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.40 / $140.96 / $142.22
| Professional | | $119.40 | $140.96 | $142.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.93 / $131.93 / $151.71
| Facility | | $131.93 | $131.93 | $151.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.93 / $131.93 / $164.91
| Professional | | $131.93 | $131.93 | $164.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.61 / $129.58 / $220.29
| Facility | | $126.61 | $129.58 | $220.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.50 / $129.58 / $140.72
| Professional | | $129.50 | $129.58 | $140.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.06 / $129.47 / $140.62
| Professional | | $110.06 | $129.47 | $140.62 |