- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.29 / $115.90 / $173.57
| Professional | | $80.29 | $115.90 | $173.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.92 / $175.55 / $211.69
| Professional | | $123.92 | $175.55 | $211.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.99 / $176.05 / $201.20
| Professional | | $165.99 | $176.05 | $201.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $66.33 / $162.69
| Professional | | $32.34 | $66.33 | $162.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $513.03 / $513.03 / $513.03
| Facility | 26 | $513.03 | $513.03 | $513.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $158.69 / $185.53
| Professional | | $134.90 | $158.69 | $185.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.84 / $142.57 / $207.39
| Professional | | $96.84 | $142.57 | $207.39 |