- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $165.96 / $977.24
| Facility | | $117.49 | $165.96 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $954.99 / $954.99 / $977.24
| Facility | 25 | $954.99 | $954.99 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $66.07 / $128.82
| Professional | | $50.12 | $66.07 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $57.54 / $114.82 / $245.47
| Professional | 25 | $57.54 | $114.82 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $83.18 / $208.93
| Professional | | $70.79 | $83.18 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $85.11 / $275.42
| Professional | | $54.95 | $85.11 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $83.18 / $154.88
| Professional | | $66.07 | $83.18 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $69.18 / $141.25
| Professional | | $48.98 | $69.18 | $141.25 |