- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.45 / $150.07 / $154.86
| Facility | | $101.45 | $150.07 | $154.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.45 / $131.87 / $211.36
| Professional | | $101.45 | $131.87 | $211.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.06 / $233.16 / $1,025.03
| Facility | | $222.06 | $233.16 | $1,025.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.02 / $122.08 / $179.66
| Professional | | $120.02 | $122.08 | $179.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.35 / $172.35 / $172.35
| Facility | | $172.35 | $172.35 | $172.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.82 / $125.82 / $177.52
| Professional | | $125.82 | $125.82 | $177.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.45 / $178.95 / $1,046.34
| Facility | | $101.45 | $178.95 | $1,046.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.08 / $120.01 / $213.15
| Professional | | $83.08 | $120.01 | $213.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.74 / $150.16 / $177.65
| Facility | | $131.74 | $150.16 | $177.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.08 / $111.62 / $160.53
| Professional | | $83.08 | $111.62 | $160.53 |