- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $138.04 / $309.03
| Professional | | $112.20 | $138.04 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $120.23 / $229.09
| Professional | | $100.00 | $120.23 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $162.18 / $295.12
| Professional | | $100.00 | $162.18 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $141.25 / $275.42 / $275.42
| Facility | 26 | $141.25 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $158.49 / $1,230.27
| Professional | | $100.00 | $158.49 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $131.83 / $245.47
| Professional | | $91.20 | $131.83 | $245.47 |