- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.92 / $161.30 / $278.63
| Professional | | $120.92 | $161.30 | $278.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.81 / $358.94 / $477.36
| Professional | | $180.81 | $358.94 | $477.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.68 / $196.28 / $376.13
| Professional | | $150.68 | $196.28 | $376.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.82 / $181.96 / $237.84
| Professional | | $138.82 | $181.96 | $237.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.47 / $182.10 / $327.02
| Professional | | $128.47 | $182.10 | $327.02 |