- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.10 / $142.40 / $227.84
| Professional | | $89.10 | $142.40 | $227.84 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $141.30 / $141.30 / $141.30
| Professional | 25 | $141.30 | $141.30 | $141.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.87 / $284.37 / $374.87
| Professional | | $198.87 | $284.37 | $374.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.47 / $133.88 / $315.06
| Professional | | $65.47 | $133.88 | $315.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $73.86 / $128.97 / $256.23
| Facility | | $73.86 | $128.97 | $256.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.76 / $219.78 / $372.00
| Professional | | $129.76 | $219.78 | $372.00 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $256.00 / $256.00 / $285.97
| Professional | 25 | $256.00 | $256.00 | $285.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.16 / $185.58 / $299.18
| Professional | | $129.16 | $185.58 | $299.18 |