- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.47 / $66.65 / $117.59
| Professional | | $50.47 | $66.65 | $117.59 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $65.68 / $106.92 / $106.92
| Professional | 25 | $65.68 | $106.92 | $106.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.40 / $76.51 / $221.46
| Professional | | $76.40 | $76.51 | $221.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.88 / $108.72 / $168.88
| Professional | | $57.88 | $108.72 | $168.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.23 / $155.30 / $155.30
| Professional | | $74.23 | $155.30 | $155.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.36 / $79.40 / $163.77
| Professional | | $49.36 | $79.40 | $163.77 |