- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.41 / $299.43 / $1,130.11
| Professional | | $189.41 | $299.43 | $1,130.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.02 / $31.02 / $278.67
| Professional | | $31.02 | $31.02 | $278.67 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.02 / $31.02 / $38.35
| Facility | 26 | $31.02 | $31.02 | $38.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.74 / $278.67 / $542.96
| Professional | | $129.74 | $278.67 | $542.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.02 / $31.02 / $38.35
| Facility | 26 | $31.02 | $31.02 | $38.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.21 / $247.94 / $337.04
| Professional | | $173.21 | $247.94 | $337.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.68 / $167.49 / $346.06
| Professional | | $146.68 | $167.49 | $346.06 |