- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.00 / $85.49 / $162.44
| Professional | | $68.00 | $85.49 | $162.44 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $127.51 / $277.99 / $277.99
| Professional | 25 | $127.51 | $277.99 | $277.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.16 / $74.98 / $331.65
| Professional | | $66.16 | $74.98 | $331.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.73 / $128.97 / $373.90
| Professional | | $71.73 | $128.97 | $373.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.32 / $178.68 / $343.02
| Professional | | $154.32 | $178.68 | $343.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.59 / $122.64 / $355.02
| Professional | | $77.59 | $122.64 | $355.02 |