- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $69.64 / $86.59 / $90.64
| Facility | 26 | $69.64 | $86.59 | $90.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.99 / $259.48 / $794.91
| Professional | | $209.99 | $259.48 | $794.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.17 / $256.75 / $425.32
| Professional | | $193.17 | $256.75 | $425.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.05 / $338.68 / $764.74
| Professional | | $218.05 | $338.68 | $764.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $192.32 / $339.11 / $339.11
| Facility | 26 | $192.32 | $339.11 | $339.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.62 / $375.75 / $1,687.36
| Professional | | $232.62 | $375.75 | $1,687.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.60 / $293.19 / $511.01
| Professional | | $196.60 | $293.19 | $511.01 |