- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.35 / $152.28 / $246.46
| Professional | | $150.35 | $152.28 | $246.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.36 / $172.93 / $245.56
| Professional | | $126.36 | $172.93 | $245.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.13 / $146.56 / $183.20
| Professional | | $122.13 | $146.56 | $183.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.61 / $295.41 / $602.83
| Professional | | $120.61 | $295.41 | $602.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.88 / $186.75 / $333.18
| Professional | | $139.88 | $186.75 | $333.18 |