- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.04 / $132.04 / $8,007.10
| Facility | | $132.04 | $132.04 | $8,007.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.15 / $143.47 / $163.95
| Professional | | $131.15 | $143.47 | $163.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.73 / $123.73 / $131.16
| Facility | | $123.73 | $123.73 | $131.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.16 / $131.16 / $131.16
| Professional | | $131.16 | $131.16 | $131.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.27 / $173.79 / $234.45
| Facility | | $144.27 | $173.79 | $234.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.16 / $144.28 / $163.95
| Professional | | $131.16 | $144.28 | $163.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.56 / $141.22 / $264.91
| Facility | | $87.56 | $141.22 | $264.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.54 / $157.38 / $157.38
| Professional | | $147.54 | $157.38 | $157.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.16 / $131.16 / $146.01
| Professional | | $131.16 | $131.16 | $146.01 |