- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $194.98 / $346.74
| Professional | | $169.82 | $194.98 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $173.78 / $331.13
| Professional | | $144.54 | $173.78 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $239.88 / $446.68
| Professional | | $144.54 | $239.88 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $120.23 / $234.42 / $234.42
| Facility | 26 | $120.23 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $239.88 / $1,318.26
| Professional | | $144.54 | $239.88 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $204.17 / $371.54
| Professional | | $131.83 | $204.17 | $371.54 |