- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.30 / $78.79 / $145.41
| Professional | | $47.30 | $78.79 | $145.41 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $92.65 / $98.41 / $103.55
| Professional | 25 | $92.65 | $98.41 | $103.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.93 / $111.91 / $328.83
| Professional | | $94.93 | $111.91 | $328.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.75 / $72.56 / $116.90
| Professional | | $46.75 | $72.56 | $116.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.90 / $79.09 / $125.09
| Professional | | $37.90 | $79.09 | $125.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.42 / $97.58 / $196.47
| Professional | | $53.42 | $97.58 | $196.47 |