- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.01 / $364.18 / $483.12
| Professional | | $304.01 | $364.18 | $483.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.45 / $70.45 / $87.10
| Facility | 26 | $70.45 | $70.45 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.32 / $566.29 / $903.08
| Professional | | $416.32 | $566.29 | $903.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.45 / $70.45 / $87.10
| Facility | 26 | $70.45 | $70.45 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.44 / $597.42 / $914.26
| Professional | | $358.44 | $597.42 | $914.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.41 / $364.51 / $713.66
| Professional | | $345.41 | $364.51 | $713.66 |