- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.05 / $151.94 / $189.64
| Professional | | $132.05 | $151.94 | $189.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.83 / $194.44 / $284.39
| Professional | | $145.83 | $194.44 | $284.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.41 / $148.30 / $380.90
| Professional | | $135.41 | $148.30 | $380.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $178.41 / $258.89
| Professional | | $2.00 | $178.41 | $258.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.25 / $1.25 / $287.67
| Professional | | $1.25 | $1.25 | $287.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.31 / $177.10 / $314.08
| Professional | | $141.31 | $177.10 | $314.08 |