- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.73 / $74.31 / $154.44
| Professional | | $41.73 | $74.31 | $154.44 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $60.00 / $89.14 / $295.00
| Professional | 25 | $60.00 | $89.14 | $295.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.84 / $72.52 / $129.02
| Professional | | $47.84 | $72.52 | $129.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.75 / $86.14 / $180.97
| Professional | | $42.75 | $86.14 | $180.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.00 / $55.00 / $98.74
| Professional | | $25.00 | $55.00 | $98.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.24 / $124.72 / $183.14
| Professional | | $58.24 | $124.72 | $183.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.86 / $82.39 / $153.62
| Professional | | $54.86 | $82.39 | $153.62 |