- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $32.00 / $75.25
| Professional | | $10.00 | $32.00 | $75.25 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $140.71 / $140.71 / $140.71
| Professional | 25 | $140.71 | $140.71 | $140.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.89 / $27.13 / $32.92
| Professional | | $17.89 | $27.13 | $32.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.23 / $20.23 / $40.00
| Professional | | $20.23 | $20.23 | $40.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.08 / $13.08 / $190.00
| Professional | | $13.08 | $13.08 | $190.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $20.00 / $33.00
| Professional | | $20.00 | $20.00 | $33.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.39 / $14.44 / $26.61
| Professional | | $9.39 | $14.44 | $26.61 |