- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $75.86 / $186.21
| Facility | 26 | $52.48 | $75.86 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $457.09 / $1,122.02
| Professional | | $346.74 | $457.09 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Professional | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $354.81 / $602.56
| Professional | | $257.04 | $354.81 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $457.09 / $870.96
| Professional | | $338.84 | $457.09 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $478.63 / $812.83
| Professional | | $323.59 | $478.63 | $812.83 |
- 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
- $457.09 / $457.09 / $457.09
| Facility | 26 | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $512.86 / $977.24
| Professional | | $436.52 | $512.86 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $436.52 / $794.33
| Professional | | $251.19 | $436.52 | $794.33 |