- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.36 / $352.73 / $415.38
| Professional | | $331.36 | $352.73 | $415.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $351.14 / $351.14 / $351.14
| Facility | 26 | $351.14 | $351.14 | $351.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.67 / $403.67 / $1,404.70
| Professional | | $403.67 | $403.67 | $1,404.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.90 / $504.04 / $1,404.70
| Professional | | $395.90 | $504.04 | $1,404.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.90 / $504.04 / $1,404.70
| Professional | | $395.90 | $504.04 | $1,404.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.82 / $388.17 / $767.17
| Professional | | $308.82 | $388.17 | $767.17 |