- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.66 / $137.36 / $171.84
| Professional | | $129.66 | $137.36 | $171.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.22 / $165.73 / $230.05
| Professional | | $131.22 | $165.73 | $230.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.34 / $129.34 / $699.00
| Facility | | $129.34 | $129.34 | $699.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.33 / $182.21 / $243.48
| Professional | | $142.33 | $182.21 | $243.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.79 / $160.72 / $251.51
| Professional | | $124.79 | $160.72 | $251.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.66 / $137.36 / $258.10
| Professional | | $133.66 | $137.36 | $258.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $163.52 / $246.12
| Professional | | $115.43 | $163.52 | $246.12 |