- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.99 / $25.99 / $54.98
| Facility | 26 | $25.99 | $25.99 | $54.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.68 / $135.82 / $615.42
| Professional | | $96.68 | $135.82 | $615.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.48 / $79.59 / $138.90
| Professional | | $24.48 | $79.59 | $138.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.68 / $150.54 / $212.93
| Professional | | $98.68 | $150.54 | $212.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $48.60 / $144.72
| Professional | | $32.34 | $48.60 | $144.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.64 / $193.30 / $281.85
| Professional | | $101.64 | $193.30 | $281.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.38 / $126.05 / $292.32
| Professional | | $119.38 | $126.05 | $292.32 |