- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.30 / $43.65 / $245.47
| Facility | | $26.30 | $43.65 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $89.13 / $239.88 / $251.19
| Facility | 25 | $89.13 | $239.88 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $53.70 / $128.82
| Professional | | $28.18 | $53.70 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $32.36 / $63.10 / $147.91
| Professional | 25 | $32.36 | $63.10 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $61.66 / $107.15
| Facility | | $33.88 | $61.66 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $47.86 / $70.79
| Professional | | $32.36 | $47.86 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $151.36 / $173.78
| Facility | | $60.26 | $151.36 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $52.48 / $112.20
| Professional | | $30.90 | $52.48 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $43.65 / $81.28
| Professional | | $25.12 | $43.65 | $81.28 |