- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.52 / $148.05 / $866.42
| Professional | | $143.52 | $148.05 | $866.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.71 / $171.04 / $228.81
| Professional | | $150.71 | $171.04 | $228.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.26 / $158.26 / $325.58
| Professional | | $158.26 | $158.26 | $325.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.20 / $145.26 / $222.25
| Professional | | $1.20 | $145.26 | $222.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.20 / $134.09 / $217.89
| Professional | | $1.20 | $134.09 | $217.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.66 / $205.45 / $297.56
| Professional | | $146.66 | $205.45 | $297.56 |