- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.07 / $171.30 / $1,034.58
| Professional | | $160.07 | $171.30 | $1,034.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.97 / $227.88 / $276.56
| Professional | | $160.97 | $227.88 | $276.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.77 / $273.07 / $317.87
| Professional | | $169.77 | $273.07 | $317.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.85 / $194.62 / $270.83
| Professional | | $1.85 | $194.62 | $270.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.85 / $155.93 / $243.27
| Professional | | $1.85 | $155.93 | $243.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.30 / $230.40 / $342.04
| Professional | | $154.30 | $230.40 | $342.04 |