- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.36 / $140.71 / $245.69
| Professional | | $88.36 | $140.71 | $245.69 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $149.25 / $243.71 / $491.00
| Professional | 25 | $149.25 | $243.71 | $491.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.11 / $189.91 / $548.41
| Professional | | $161.11 | $189.91 | $548.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.09 / $100.75 / $204.39
| Professional | | $61.09 | $100.75 | $204.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.73 / $137.41 / $220.15
| Professional | | $71.73 | $137.41 | $220.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.98 / $166.60 / $213.63
| Professional | | $79.98 | $166.60 | $213.63 |