- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $45.30 / $93.20
| Professional | | $40.00 | $45.30 | $93.20 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $64.63 / $68.34 / $77.09
| Professional | 25 | $64.63 | $68.34 | $77.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.11 / $40.31 / $170.25
| Professional | | $35.11 | $40.31 | $170.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.24 / $72.04 / $225.52
| Professional | | $39.24 | $72.04 | $225.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.86 / $107.53 / $206.89
| Professional | | $92.86 | $107.53 | $206.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.28 / $74.20 / $231.53
| Professional | | $53.28 | $74.20 | $231.53 |