- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.16 / $147.18 / $570.15
| Facility | | $132.16 | $147.18 | $570.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $139.84 / $181.27
| Professional | | $129.47 | $139.84 | $181.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.19 / $148.87 / $156.69
| Facility | | $133.19 | $148.87 | $156.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.91 / $133.91 / $133.91
| Professional | | $133.91 | $133.91 | $133.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.15 / $122.15 / $129.47
| Facility | | $122.15 | $122.15 | $129.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $129.47 / $129.47
| Professional | | $129.47 | $129.47 | $129.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.58 / $147.18 / $181.41
| Facility | | $129.58 | $147.18 | $181.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.50 / $129.58 / $143.00
| Professional | | $129.50 | $129.58 | $143.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $129.47 / $145.76
| Professional | | $129.47 | $129.47 | $145.76 |