- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.81 / $73.90 / $175.77
| Professional | | $43.81 | $73.90 | $175.77 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $46.40 / $87.47 / $153.44
| Professional | 25 | $46.40 | $87.47 | $153.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.00 / $84.00 / $130.00
| Professional | | $69.00 | $84.00 | $130.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.00 / $170.00 / $185.00
| Facility | | $170.00 | $170.00 | $185.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.21 / $92.64 / $143.16
| Professional | | $60.21 | $92.64 | $143.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.67 / $128.40 / $211.61
| Professional | | $78.67 | $128.40 | $211.61 |