- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.12 / $138.25 / $256.51
| Professional | | $88.12 | $138.25 | $256.51 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $110.41 / $159.32 / $404.60
| Professional | 25 | $110.41 | $159.32 | $404.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.71 / $203.16 / $263.14
| Professional | | $95.71 | $203.16 | $263.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.36 / $116.36 / $116.36
| Professional | | $116.36 | $116.36 | $116.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.69 / $215.18 / $310.33
| Professional | | $153.69 | $215.18 | $310.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.38 / $127.73 / $262.89
| Professional | | $117.38 | $127.73 | $262.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.05 / $166.08 / $267.58
| Professional | | $107.05 | $166.08 | $267.58 |