- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $147.91 / $338.84
| Professional | | $79.43 | $147.91 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $144.54 / $229.09 / $398.11
| Professional | 25 | $144.54 | $229.09 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $141.25 / $154.88
| Professional | | $123.03 | $141.25 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $177.83 / $186.21 / $275.42
| Professional | 25 | $177.83 | $186.21 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $147.91 / $275.42
| Professional | | $93.33 | $147.91 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $134.90 / $245.47
| Professional | | $79.43 | $134.90 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $1,202.26 / $1,202.26
| Professional | | $147.91 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $107.15 / $162.18
| Professional | | $69.18 | $107.15 | $162.18 |