- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.89 / $72.64 / $139.72
| Professional | | $42.89 | $72.64 | $139.72 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $80.54 / $92.20 / $92.20
| Professional | 25 | $80.54 | $92.20 | $92.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.49 / $106.66 / $313.83
| Professional | | $90.49 | $106.66 | $313.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.52 / $68.59 / $110.62
| Professional | | $42.52 | $68.59 | $110.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.65 / $73.01 / $119.39
| Professional | | $35.65 | $73.01 | $119.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.53 / $95.89 / $119.92
| Professional | | $61.53 | $95.89 | $119.92 |