- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Facility | 26 | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $251.19 / $537.03
| Professional | | $177.83 | $251.19 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | 26 | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $457.09 / $478.63
| Professional | | $407.38 | $457.09 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $338.84 / $478.63
| Professional | | $181.97 | $338.84 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $489.78 / $562.34
| Professional | | $281.84 | $489.78 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | 26 | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $457.09 / $562.34
| Professional | | $363.08 | $457.09 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $263.03 / $549.54
| Professional | | $234.42 | $263.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $251.19 / $380.19
| Professional | | $208.93 | $251.19 | $380.19 |