- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.46 / $60.77 / $439.65
| Facility | | $33.46 | $60.77 | $439.65 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $177.65 / $243.75 / $433.50
| Facility | 25 | $177.65 | $243.75 | $433.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.10 / $45.58 / $77.25
| Professional | | $31.10 | $45.58 | $77.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.63 / $46.36 / $117.49
| Professional | | $38.63 | $46.36 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.94 / $54.52 / $64.76
| Professional | | $41.94 | $54.52 | $64.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $625.00 / $625.00
| Facility | | $625.00 | $625.00 | $625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.65 / $46.15 / $120.10
| Professional | | $32.65 | $46.15 | $120.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.07 / $37.72 / $57.71
| Professional | | $31.07 | $37.72 | $57.71 |