- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.18 / $140.37 / $336.89
| Professional | | $78.18 | $140.37 | $336.89 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $125.60 / $142.27 / $448.15
| Professional | 25 | $125.60 | $142.27 | $448.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.56 / $121.56 / $161.66
| Professional | | $121.56 | $121.56 | $161.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.36 / $116.36 / $153.83
| Professional | | $116.36 | $116.36 | $153.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.16 / $156.50 / $297.61
| Professional | | $135.16 | $156.50 | $297.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.17 / $126.72 / $307.92
| Professional | | $91.17 | $126.72 | $307.92 |