- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.20 / $117.98 / $183.44
| Professional | | $90.20 | $117.98 | $183.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.47 / $190.04 / $225.73
| Professional | | $146.47 | $190.04 | $225.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.67 / $187.37 / $214.14
| Professional | | $176.67 | $187.37 | $214.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $82.63 / $153.99
| Professional | | $32.34 | $82.63 | $153.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $217.18 / $217.18 / $217.18
| Facility | 26 | $217.18 | $217.18 | $217.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.51 / $167.66 / $195.20
| Professional | | $142.51 | $167.66 | $195.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.62 / $157.93 / $237.99
| Professional | | $115.62 | $157.93 | $237.99 |