- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.00 / $73.76 / $116.55
| Professional | | $42.00 | $73.76 | $116.55 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $48.66 / $94.52 / $209.56
| Professional | 25 | $48.66 | $94.52 | $209.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.00 / $85.46 / $149.10
| Professional | | $55.00 | $85.46 | $149.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.93 / $74.45 / $127.32
| Professional | | $47.93 | $74.45 | $127.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.94 / $79.81 / $123.70
| Facility | | $47.94 | $79.81 | $123.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.06 / $106.03 / $151.77
| Professional | | $61.06 | $106.03 | $151.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.70 / $94.35 / $154.37
| Professional | | $63.70 | $94.35 | $154.37 |