- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.19 / $181.99 / $242.66
| Facility | | $119.19 | $181.99 | $242.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.75 / $180.00 / $420.75
| Professional | | $128.75 | $180.00 | $420.75 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $234.12 / $354.38 / $354.38
| Professional | 25 | $234.12 | $354.38 | $354.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.83 / $334.89 / $439.76
| Professional | | $285.83 | $334.89 | $439.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.91 / $377.77 / $605.50
| Professional | | $198.91 | $377.77 | $605.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.62 / $190.70 / $296.51
| Facility | | $157.62 | $190.70 | $296.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.54 / $234.50 / $1,234.10
| Professional | | $171.54 | $234.50 | $1,234.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.75 / $201.20 / $320.43
| Professional | | $148.75 | $201.20 | $320.43 |