- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.47 / $317.13 / $519.67
| Professional | | $217.47 | $317.13 | $519.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.62 / $355.44 / $428.62
| Professional | | $313.62 | $355.44 | $428.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.44 / $351.52 / $418.19
| Professional | | $331.44 | $351.52 | $418.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $132.54 / $322.49
| Professional | | $32.34 | $132.54 | $322.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $516.30 / $516.30 / $516.30
| Facility | 26 | $516.30 | $516.30 | $516.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.35 / $349.35 / $425.90
| Professional | | $349.35 | $349.35 | $425.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.40 / $274.74 / $446.96
| Professional | | $201.40 | $274.74 | $446.96 |