- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.89 / $46.89 / $46.89
| Facility | 26 | $46.89 | $46.89 | $46.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.41 / $324.99 / $477.41
| Professional | | $289.41 | $324.99 | $477.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.44 / $368.76 / $541.75
| Professional | | $313.44 | $368.76 | $541.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.72 / $512.16 / $664.18
| Professional | | $359.72 | $512.16 | $664.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.42 / $399.65 / $749.84
| Professional | | $345.42 | $399.65 | $749.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.41 / $350.81 / $512.62
| Professional | | $289.41 | $350.81 | $512.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.33 / $451.76 / $634.04
| Professional | | $296.33 | $451.76 | $634.04 |