- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.82 / $29.82 / $188.32
| Facility | 26 | $29.82 | $29.82 | $188.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.92 / $198.65 / $329.60
| Professional | | $189.92 | $198.65 | $329.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.99 / $267.58 / $473.75
| Professional | | $179.99 | $267.58 | $473.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.11 / $310.22 / $528.62
| Professional | | $174.11 | $310.22 | $528.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.73 / $168.58 / $168.58
| Facility | 26 | $81.73 | $168.58 | $168.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,447.02 / $1,447.02 / $1,798.95
| Professional | | $1,447.02 | $1,447.02 | $1,798.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.79 / $265.27 / $554.21
| Professional | | $163.79 | $265.27 | $554.21 |