- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $166.95 / $266.55 / $343.53
| Facility | 26 | $166.95 | $266.55 | $343.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.16 / $577.39 / $747.95
| Professional | | $375.16 | $577.39 | $747.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.18 / $905.43 / $1,074.25
| Professional | | $302.18 | $905.43 | $1,074.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.34 / $733.82 / $1,173.36
| Professional | | $465.34 | $733.82 | $1,173.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.95 / $634.91 / $765.32
| Professional | | $374.95 | $634.91 | $765.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.72 / $610.33 / $1,177.15
| Professional | | $373.72 | $610.33 | $1,177.15 |