- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $251.72 / $251.72 / $251.72
| Facility | 26 | $251.72 | $251.72 | $251.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.65 / $343.81 / $581.37
| Professional | | $233.65 | $343.81 | $581.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.27 / $445.50 / $542.62
| Professional | | $296.27 | $445.50 | $542.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.51 / $554.16 / $749.51
| Professional | | $522.51 | $554.16 | $749.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $175.31 / $567.94
| Professional | | $32.34 | $175.31 | $567.94 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $657.04 / $657.04 / $657.04
| Facility | 26 | $657.04 | $657.04 | $657.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.36 / $665.82 / $749.50
| Professional | | $589.36 | $665.82 | $749.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.60 / $350.35 / $550.11
| Professional | | $290.60 | $350.35 | $550.11 |