- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.63 / $101.63 / $135.41
| Facility | | $101.63 | $101.63 | $135.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.31 / $105.33 / $160.77
| Professional | | $100.31 | $105.33 | $160.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.14 / $203.85 / $896.15
| Facility | | $194.14 | $203.85 | $896.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.53 / $105.27 / $157.13
| Professional | | $96.53 | $105.27 | $157.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.22 / $112.22 / $112.22
| Facility | | $112.22 | $112.22 | $112.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.92 / $81.92 / $81.92
| Professional | | $81.92 | $81.92 | $81.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.08 / $157.13 / $908.81
| Facility | | $97.08 | $157.13 | $908.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.06 / $96.86 / $235.99
| Professional | | $72.06 | $96.86 | $235.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.06 / $96.86 / $168.11
| Professional | | $72.06 | $96.86 | $168.11 |