- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.95 / $145.52 / $288.63
| Professional | | $74.95 | $145.52 | $288.63 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $80.00 / $171.45 / $294.50
| Professional | 25 | $80.00 | $171.45 | $294.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.90 / $141.44 / $226.56
| Professional | | $94.90 | $141.44 | $226.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.69 / $156.68 / $315.25
| Professional | | $80.69 | $156.68 | $315.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.00 / $120.00 / $178.04
| Professional | | $70.00 | $120.00 | $178.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.13 / $227.33 / $321.00
| Professional | | $106.13 | $227.33 | $321.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.68 / $147.91 / $290.07
| Professional | | $99.68 | $147.91 | $290.07 |