- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.81 / $105.10 / $120.60
| Facility | | $78.81 | $105.10 | $120.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.18 / $86.00 / $111.10
| Professional | | $64.18 | $86.00 | $111.10 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $72.64 / $97.51 / $133.09
| Professional | 25 | $72.64 | $97.51 | $133.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.84 / $102.10 / $137.54
| Professional | | $77.84 | $102.10 | $137.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $89.24 / $99.99 / $134.99
| Professional | 25 | $89.24 | $99.99 | $134.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.95 / $92.34 / $138.69
| Professional | | $64.95 | $92.34 | $138.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.00 / $134.00 / $145.00
| Facility | | $115.00 | $134.00 | $145.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.40 / $100.61 / $214.66
| Professional | | $69.40 | $100.61 | $214.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.55 / $92.95 / $133.62
| Professional | | $76.55 | $92.95 | $133.62 |