- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.78 / $68.34 / $98.55
| Professional | | $47.78 | $68.34 | $98.55 |
- 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
- $29.04 / $54.45 / $92.93
| Professional | | $29.04 | $54.45 | $92.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $79.09 / $200.13
| Professional | | $45.00 | $79.09 | $200.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.80 / $108.13 / $221.77
| Professional | | $54.80 | $108.13 | $221.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.91 / $101.86 / $216.90
| Professional | | $51.91 | $101.86 | $216.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.76 / $56.65 / $97.69
| Professional | | $43.76 | $56.65 | $97.69 |