- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.44 / $250.77 / $1,435.13
| Professional | | $165.44 | $250.77 | $1,435.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.11 / $155.11 / $401.71
| Professional | | $155.11 | $155.11 | $401.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $155.11 / $155.11 / $191.75
| Facility | 26 | $155.11 | $155.11 | $191.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.31 / $348.20 / $556.52
| Professional | | $185.31 | $348.20 | $556.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $155.11 / $155.11 / $191.75
| Facility | 26 | $155.11 | $155.11 | $191.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.65 / $421.12 / $701.73
| Professional | | $252.65 | $421.12 | $701.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.43 / $252.63 / $443.66
| Professional | | $202.43 | $252.63 | $443.66 |