- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.18 / $190.33 / $291.13
| Professional | | $163.18 | $190.33 | $291.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.12 / $166.83 / $208.54
| Professional | | $125.12 | $166.83 | $208.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $167.09 / $167.09 / $167.09
| Facility | 26 | $167.09 | $167.09 | $167.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.55 / $205.85 / $426.98
| Professional | | $102.55 | $205.85 | $426.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $337.61 / $658.52 / $658.52
| Facility | 26 | $337.61 | $658.52 | $658.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.77 / $204.27 / $1,346.60
| Professional | | $154.77 | $204.27 | $1,346.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.69 / $194.06 / $360.81
| Professional | | $154.69 | $194.06 | $360.81 |