- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | 26 | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $204.17 / $407.38
| Professional | | $169.82 | $204.17 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $263.03 / $436.52
| Professional | | $213.80 | $263.03 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $316.23
| Professional | | $32.36 | $33.11 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Facility | 26 | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $302.00 / $549.54
| Professional | | $204.17 | $302.00 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $302.00 / $389.05
| Professional | | $194.98 | $302.00 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $213.80 / $371.54
| Professional | | $50.12 | $213.80 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $213.80 / $323.59
| Professional | | $162.18 | $213.80 | $323.59 |