- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.40 / $236.15 / $445.31
| Professional | | $194.40 | $236.15 | $445.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.44 / $171.26 / $214.08
| Professional | | $128.44 | $171.26 | $214.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.81 / $274.50 / $432.01
| Professional | | $204.81 | $274.50 | $432.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $192.32 / $339.11 / $339.11
| Facility | 26 | $192.32 | $339.11 | $339.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.44 / $257.14 / $1,687.36
| Professional | | $189.44 | $257.14 | $1,687.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.84 / $233.56 / $438.67
| Professional | | $187.84 | $233.56 | $438.67 |