- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.78 / $121.78 / $131.22
| Facility | | $121.78 | $121.78 | $131.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.49 / $54.61 / $72.08
| Professional | | $52.49 | $54.61 | $72.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.68 / $58.35 / $166.34
| Facility | | $46.68 | $58.35 | $166.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.49 / $52.49 / $54.47
| Professional | | $52.49 | $52.49 | $54.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.40 / $52.49 / $52.96
| Facility | | $49.40 | $52.49 | $52.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.49 / $52.49 / $52.49
| Professional | | $52.49 | $52.49 | $52.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.49 / $52.49 / $52.49
| Professional | | $52.49 | $52.49 | $52.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.78 / $121.78 / $131.22
| Facility | | $121.78 | $121.78 | $131.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.49 / $57.42 / $72.08
| Professional | | $52.49 | $57.42 | $72.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.49 / $52.49 / $76.11
| Professional | | $52.49 | $52.49 | $76.11 |