- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.74 / $70.68 / $104.34
| Professional | | $42.74 | $70.68 | $104.34 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $89.80 / $89.80 / $135.00
| Professional | 25 | $89.80 | $89.80 | $135.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.83 / $75.48 / $113.32
| Professional | | $73.83 | $75.48 | $113.32 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $105.99 / $105.99 / $113.32
| Professional | 25 | $105.99 | $105.99 | $113.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.18 / $69.69 / $140.40
| Professional | | $37.18 | $69.69 | $140.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.09 / $71.06 / $140.13
| Professional | | $42.09 | $71.06 | $140.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.83 / $544.05 / $690.83
| Professional | | $308.83 | $544.05 | $690.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.37 / $74.41 / $98.36
| Professional | | $50.37 | $74.41 | $98.36 |