- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.11 / $106.11 / $127.33
| Facility | | $106.11 | $106.11 | $127.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.55 / $82.34 / $106.11
| Professional | | $77.55 | $82.34 | $106.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.45 / $188.45 / $223.39
| Facility | | $188.45 | $188.45 | $223.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.01 / $101.01 / $110.07
| Professional | | $101.01 | $101.01 | $110.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.78 / $107.78 / $107.78
| Facility | | $107.78 | $107.78 | $107.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.68 / $78.68 / $107.78
| Professional | | $78.68 | $78.68 | $107.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.58 / $152.58 / $470.94
| Professional | | $152.58 | $152.58 | $470.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.04 / $89.55 / $100.39
| Facility | | $53.04 | $89.55 | $100.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.68 / $94.01 / $131.68
| Professional | | $62.68 | $94.01 | $131.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.13 / $155.25 / $197.60
| Professional | | $141.13 | $155.25 | $197.60 |