- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.03 / $76.23 / $90.71
| Facility | | $68.03 | $76.23 | $90.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.70 / $77.11 / $96.51
| Professional | | $66.70 | $77.11 | $96.51 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $20.57 / $20.57 / $20.57
| Professional | 25 | $20.57 | $20.57 | $20.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.12 / $87.32 / $87.32
| Professional | | $61.12 | $87.32 | $87.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.65 / $97.13 / $306.63
| Professional | | $59.65 | $97.13 | $306.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.07 / $80.78 / $104.81
| Professional | | $63.07 | $80.78 | $104.81 |