- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.71 / $175.35 / $238.69
| Professional | | $157.71 | $175.35 | $238.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.44 / $224.46 / $270.67
| Professional | | $158.44 | $224.46 | $270.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.70 / $238.32 / $272.36
| Professional | | $224.70 | $238.32 | $272.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $42.40 / $217.93
| Professional | | $32.34 | $42.40 | $217.93 |
- 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
- $200.02 / $235.32 / $265.26
| Professional | | $200.02 | $235.32 | $265.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.16 / $213.30 / $376.66
| Professional | | $142.16 | $213.30 | $376.66 |