- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.79 / $96.35 / $142.41
| Professional | | $72.79 | $96.35 | $142.41 |
- 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
- 25
- Low / Median / High Price
- $281.00 / $281.00 / $281.00
| Professional | 25 | $281.00 | $281.00 | $281.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.75 / $80.23 / $131.59
| Professional | | $43.75 | $80.23 | $131.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.00 / $115.63 / $280.89
| Professional | | $65.00 | $115.63 | $280.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.58 / $157.33 / $314.19
| Professional | | $82.58 | $157.33 | $314.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.28 / $149.02 / $308.86
| Professional | | $83.28 | $149.02 | $308.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.48 / $85.29 / $138.85
| Professional | | $60.48 | $85.29 | $138.85 |