- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.63 / $90.10 / $123.58
| Professional | | $49.63 | $90.10 | $123.58 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $73.05 / $92.38 / $118.22
| Professional | 25 | $73.05 | $92.38 | $118.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.81 / $77.81 / $140.38
| Professional | | $77.81 | $77.81 | $140.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $80.00 / $139.68
| Professional | | $50.00 | $80.00 | $139.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.49 / $58.19 / $102.38
| Facility | | $39.49 | $58.19 | $102.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.87 / $84.76 / $140.38
| Professional | | $51.87 | $84.76 | $140.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.20 / $139.43 / $166.82
| Professional | | $101.20 | $139.43 | $166.82 |