- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.49 / $102.94 / $227.54
| Facility | | $101.49 | $102.94 | $227.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.49 / $102.94 / $170.32
| Professional | | $101.49 | $102.94 | $170.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.40 / $110.70 / $116.53
| Facility | | $87.40 | $110.70 | $116.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.15 / $113.73 / $116.53
| Professional | | $109.15 | $113.73 | $116.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.94 / $112.76 / $140.94
| Professional | | $102.94 | $112.76 | $140.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.49 / $166.50 / $697.75
| Facility | | $101.49 | $166.50 | $697.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.49 / $101.49 / $111.64
| Professional | | $101.49 | $101.49 | $111.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.82 / $197.66 / $265.43
| Facility | | $132.82 | $197.66 | $265.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.78 / $130.03 / $169.42
| Professional | | $121.78 | $130.03 | $169.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.93 / $102.93 / $102.93
| Facility | | $102.93 | $102.93 | $102.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.79 / $102.94 / $113.23
| Professional | | $97.79 | $102.94 | $113.23 |