- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.99 / $92.44 / $92.44
| Facility | 26 | $44.99 | $92.44 | $92.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.17 / $82.38 / $107.84
| Professional | | $66.17 | $82.38 | $107.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.63 / $113.06 / $183.31
| Professional | | $77.63 | $113.06 | $183.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.45 / $127.60 / $247.65
| Professional | | $83.45 | $127.60 | $247.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.33 / $140.35 / $274.30
| Professional | | $87.33 | $140.35 | $274.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.64 / $125.63 / $281.51
| Professional | | $86.64 | $125.63 | $281.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.44 / $76.97 / $116.25
| Professional | | $63.44 | $76.97 | $116.25 |