- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.15 / $170.45 / $348.97
| Facility | | $146.15 | $170.45 | $348.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.65 / $185.83 / $299.98
| Professional | | $137.65 | $185.83 | $299.98 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $234.12 / $234.12 / $234.12
| Professional | 25 | $234.12 | $234.12 | $234.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.14 / $322.68 / $371.33
| Professional | | $233.14 | $322.68 | $371.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.00 / $183.92 / $346.97
| Professional | | $70.00 | $183.92 | $346.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.26 / $177.95 / $265.08
| Professional | | $130.26 | $177.95 | $265.08 |