- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.24 / $204.85 / $327.63
| Professional | | $110.24 | $204.85 | $327.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.59 / $118.53 / $162.38
| Professional | | $108.59 | $118.53 | $162.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.78 / $225.49 / $413.27
| Professional | | $119.78 | $225.49 | $413.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.61 / $277.69 / $389.98
| Professional | | $182.61 | $277.69 | $389.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.82 / $252.10 / $438.46
| Professional | | $180.82 | $252.10 | $438.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.90 / $271.94 / $335.63
| Professional | | $184.90 | $271.94 | $335.63 |