- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.08 / $90.61 / $93.97
| Facility | | $64.08 | $90.61 | $93.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.84 / $90.83 / $98.04
| Professional | | $77.84 | $90.83 | $98.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.74 / $176.29 / $185.28
| Facility | | $109.74 | $176.29 | $185.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.46 / $103.25 / $107.22
| Professional | | $82.46 | $103.25 | $107.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.22 / $246.81 / $311.20
| Facility | | $132.22 | $246.81 | $311.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.29 / $220.36 / $290.88
| Professional | | $176.29 | $220.36 | $290.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.16 / $110.16 / $224.58
| Facility | | $110.16 | $110.16 | $224.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.42 / $110.16 / $941.30
| Professional | | $80.42 | $110.16 | $941.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.13 / $112.36 / $140.44
| Professional | | $92.13 | $112.36 | $140.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.64 / $87.95 / $117.80
| Professional | | $58.64 | $87.95 | $117.80 |