- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.66 / $135.13 / $154.83
| Facility | | $125.66 | $135.13 | $154.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.66 / $142.25 / $219.06
| Professional | | $125.66 | $142.25 | $219.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.52 / $166.52 / $166.52
| Facility | | $166.52 | $166.52 | $166.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.56 / $121.56 / $177.52
| Professional | | $121.56 | $121.56 | $177.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.92 / $195.93 / $195.93
| Facility | | $101.92 | $195.93 | $195.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.28 / $195.93 / $294.32
| Professional | | $140.28 | $195.93 | $294.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.57 / $128.58 / $141.43
| Professional | | $83.57 | $128.58 | $141.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.40 / $146.83 / $200.33
| Professional | | $126.40 | $146.83 | $200.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.58 / $128.58 / $161.26
| Professional | | $128.58 | $128.58 | $161.26 |