- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $30.00 / $85.85
| Professional | | $10.00 | $30.00 | $85.85 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $12.30 / $12.30 / $140.71
| Professional | 25 | $12.30 | $12.30 | $140.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.75 / $18.55 / $122.93
| Professional | | $12.75 | $18.55 | $122.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.77 / $20.18 / $37.02
| Professional | | $18.77 | $20.18 | $37.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.44 / $21.60 / $31.28
| Professional | | $14.44 | $21.60 | $31.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.44 / $22.01 / $34.79
| Professional | | $14.44 | $22.01 | $34.79 |