- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $173.78 / $398.11
| Professional | | $95.50 | $173.78 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $302.00 / $302.00 / $302.00
| Facility | 26 | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $173.78 / $398.11
| Professional | | $147.91 | $173.78 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $181.97 / $501.19
| Professional | | $154.88 | $181.97 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $123.03 / $501.19
| Professional | | $120.23 | $123.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $144.54 / $316.23
| Professional | | $117.49 | $144.54 | $316.23 |