- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.59 / $65.47 / $83.21
| Professional | | $58.59 | $65.47 | $83.21 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $1.53 / $67.70 / $79.90
| Professional | 25 | $1.53 | $67.70 | $79.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.84 / $77.34 / $94.00
| Professional | | $71.84 | $77.34 | $94.00 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $71.79 / $78.45 / $95.72
| Professional | 25 | $71.79 | $78.45 | $95.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.90 / $149.82 / $162.80
| Facility | | $128.90 | $149.82 | $162.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.49 / $83.64 / $97.77
| Professional | | $59.49 | $83.64 | $97.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.33 / $102.33 / $266.70
| Professional | | $68.33 | $102.33 | $266.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.11 / $76.81 / $112.80
| Professional | | $62.11 | $76.81 | $112.80 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $99.10 / $99.10 / $99.10
| Professional | 25 | $99.10 | $99.10 | $99.10 |