- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $83.18 / $117.49
| Professional | | $42.66 | $83.18 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $85.11 / $85.11 / $85.11
| Professional | 25 | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $70.79 / $134.90
| Professional | | $63.10 | $70.79 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $79.43 / $131.83
| Professional | | $48.98 | $79.43 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $97.72 / $147.91
| Facility | | $75.86 | $97.72 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $97.72 / $147.91
| Professional | | $75.86 | $97.72 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $69.18 / $117.49
| Facility | | $41.69 | $69.18 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $79.43 / $131.83
| Professional | | $47.86 | $79.43 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $85.11 / $147.91
| Professional | | $60.26 | $85.11 | $147.91 |