- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.50 / $27.21 / $75.25
| Professional | | $10.50 | $27.21 | $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
- $23.33 / $55.08 / $58.71
| Professional | | $23.33 | $55.08 | $58.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.73 / $43.96 / $51.26
| Professional | | $19.73 | $43.96 | $51.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.80 / $38.76 / $65.76
| Professional | | $24.80 | $38.76 | $65.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.33 / $38.94 / $55.20
| Professional | | $22.33 | $38.94 | $55.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.80 / $52.80 / $52.80
| Professional | | $52.80 | $52.80 | $52.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.44 / $26.61 / $59.62
| Professional | | $14.44 | $26.61 | $59.62 |