- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $109.65 / $239.88
| Professional | | $60.26 | $109.65 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $72.44 / $194.98 / $346.74
| Professional | 25 | $72.44 | $194.98 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $120.23 / $186.21
| Professional | | $74.13 | $120.23 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $107.15 / $117.49 / $125.89
| Professional | 25 | $107.15 | $117.49 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $89.13 / $147.91
| Professional | | $58.88 | $89.13 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $95.50 / $173.78
| Professional | | $60.26 | $95.50 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $109.65 / $177.83
| Facility | | $66.07 | $109.65 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $81.28 / $123.03
| Professional | | $52.48 | $81.28 | $123.03 |