- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.84 / $163.12 / $204.40
| Professional | | $140.84 | $163.12 | $204.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.05 / $239.55 / $288.87
| Professional | | $197.05 | $239.55 | $288.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.37 / $249.64 / $285.30
| Professional | | $235.37 | $249.64 | $285.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $96.13 / $233.15
| Professional | | $32.34 | $96.13 | $233.15 |
- 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
- $191.56 / $225.37 / $265.38
| Professional | | $191.56 | $225.37 | $265.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.97 / $217.00 / $289.68
| Professional | | $159.97 | $217.00 | $289.68 |