- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $74.13 / $173.78
| Professional | | $38.02 | $74.13 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $87.10 / $173.78 / $295.12
| Professional | 25 | $87.10 | $173.78 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $72.44 / $162.18
| Professional | | $48.98 | $72.44 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $87.10 / $204.17
| Professional | | $42.66 | $87.10 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $63.10 / $114.82
| Professional | | $46.77 | $63.10 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $125.89 / $208.93
| Professional | | $58.88 | $125.89 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $61.66 / $120.23
| Professional | | $35.48 | $61.66 | $120.23 |