- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $76.23 / $191.66
| Professional | | $40.00 | $76.23 | $191.66 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $76.23 / $109.62 / $425.40
| Professional | 25 | $76.23 | $109.62 | $425.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.21 / $40.31 / $82.73
| Professional | | $37.21 | $40.31 | $82.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.79 / $68.48 / $140.30
| Professional | | $39.79 | $68.48 | $140.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.02 / $102.64 / $146.63
| Professional | | $86.02 | $102.64 | $146.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.08 / $71.97 / $143.66
| Professional | | $48.08 | $71.97 | $143.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.00 / $65.00 / $95.26
| Professional | | $48.00 | $65.00 | $95.26 |