- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.59 / $246.69 / $265.83
| Facility | | $110.59 | $246.69 | $265.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.32 / $110.59 / $164.61
| Professional | | $106.32 | $110.59 | $164.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.57 / $118.21 / $336.96
| Facility | | $94.57 | $118.21 | $336.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $106.33 / $116.96
| Professional | | $106.33 | $106.33 | $116.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.33 / $106.33 / $354.88
| Facility | | $106.33 | $106.33 | $354.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $106.33 / $106.33
| Professional | | $106.33 | $106.33 | $106.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $106.33 / $106.33
| Professional | | $106.33 | $106.33 | $106.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.69 / $246.69 / $265.83
| Facility | | $246.69 | $246.69 | $265.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $111.65 / $164.61
| Professional | | $106.33 | $111.65 | $164.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $106.33 / $167.65
| Professional | | $106.33 | $106.33 | $167.65 |