- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.99 / $64.68 / $95.95
| Facility | 26 | $53.99 | $64.68 | $95.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.65 / $236.86 / $316.31
| Professional | | $201.65 | $236.86 | $316.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.48 / $310.32 / $460.73
| Professional | | $225.48 | $310.32 | $460.73 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.44 / $74.44 / $74.68
| Facility | 26 | $74.44 | $74.44 | $74.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.70 / $323.24 / $536.24
| Professional | | $230.70 | $323.24 | $536.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.74 / $293.62 / $534.26
| Professional | | $218.74 | $293.62 | $534.26 |