- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.30 / $60.40 / $71.06
| Facility | | $53.30 | $60.40 | $71.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.85 / $61.52 / $76.70
| Professional | | $11.85 | $61.52 | $76.70 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $14.48 / $70.06 / $76.20
| Professional | 25 | $14.48 | $70.06 | $76.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.03 / $53.03 / $61.63
| Professional | | $53.03 | $53.03 | $61.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.86 / $79.86 / $167.03
| Professional | | $79.86 | $79.86 | $167.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.27 / $79.83 / $164.59
| Professional | | $50.27 | $79.83 | $164.59 |