- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.59 / $94.41 / $128.34
| Professional | | $60.59 | $94.41 | $128.34 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $90.99 / $94.41 / $96.86
| Professional | 25 | $90.99 | $94.41 | $96.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.10 / $101.10 / $110.76
| Professional | | $101.10 | $101.10 | $110.76 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $83.26 / $112.72 / $149.53
| Professional | 25 | $83.26 | $112.72 | $149.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.80 / $98.58 / $108.44
| Professional | | $60.80 | $98.58 | $108.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.00 / $80.65 / $149.11
| Professional | | $55.00 | $80.65 | $149.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.68 / $107.79 / $134.53
| Professional | | $89.68 | $107.79 | $134.53 |