- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $478.63 / $602.56
| Professional | | $288.40 | $478.63 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Facility | 26 | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $1,174.90
| Professional | | $416.87 | $416.87 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $794.33 / $1,348.96
| Professional | | $363.08 | $794.33 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $1,174.90
| Professional | | $426.58 | $426.58 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $602.56 / $1,047.13
| Professional | | $302.00 | $602.56 | $1,047.13 |