- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.49 / $89.31 / $121.50
| Professional | | $52.49 | $89.31 | $121.50 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $64.63 / $266.89 / $266.89
| Professional | 25 | $64.63 | $266.89 | $266.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.02 / $125.52 / $223.90
| Professional | | $112.02 | $125.52 | $223.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.67 / $84.09 / $188.33
| Professional | | $36.67 | $84.09 | $188.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.62 / $80.48 / $152.87
| Facility | | $44.62 | $80.48 | $152.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.00 / $130.85 / $329.60
| Professional | | $85.00 | $130.85 | $329.60 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $100.00 / $100.00 / $145.28
| Professional | 25 | $100.00 | $100.00 | $145.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.00 / $111.10 / $183.63
| Professional | | $49.00 | $111.10 | $183.63 |