- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.81 / $70.81 / $89.99
| Facility | 26 | $70.81 | $70.81 | $89.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.00 / $221.97 / $253.20
| Professional | | $202.00 | $221.97 | $253.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.57 / $146.83 / $268.04
| Professional | | $143.57 | $146.83 | $268.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.89 / $137.19 / $315.14
| Professional | | $78.89 | $137.19 | $315.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.69 / $83.69 / $83.69
| Facility | 26 | $83.69 | $83.69 | $83.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.29 / $289.35 / $387.26
| Professional | | $195.29 | $289.35 | $387.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $238.40
| Professional | | $32.34 | $32.34 | $238.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.82 / $207.70 / $301.20
| Professional | | $167.82 | $207.70 | $301.20 |