- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.09 / $116.87 / $213.40
| Professional | | $29.09 | $116.87 | $213.40 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $27.79 / $134.79 / $209.47
| Professional | 25 | $27.79 | $134.79 | $209.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.50 / $113.28 / $191.52
| Professional | | $76.50 | $113.28 | $191.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.22 / $117.50 / $266.58
| Professional | | $65.22 | $117.50 | $266.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.00 / $110.00 / $257.72
| Professional | | $70.00 | $110.00 | $257.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.52 / $79.52 / $231.73
| Professional | | $79.52 | $79.52 | $231.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.30 / $120.70 / $235.80
| Professional | | $75.30 | $120.70 | $235.80 |