- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.70 / $28.70 / $37.79
| Facility | | $28.70 | $28.70 | $37.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.32 / $34.28 / $52.32
| Professional | | $25.32 | $34.28 | $52.32 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $37.21 / $37.21 / $51.58
| Professional | 25 | $37.21 | $37.21 | $51.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.46 / $45.15 / $64.00
| Professional | | $34.46 | $45.15 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.91 / $58.17 / $68.44
| Professional | | $47.91 | $58.17 | $68.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.86 / $47.25 / $60.26
| Professional | | $35.86 | $47.25 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.00 / $44.00 / $66.00
| Professional | | $33.00 | $44.00 | $66.00 |