- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $100.00 / $234.42
| Facility | | $64.57 | $100.00 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $102.33 / $190.55 / $204.17
| Facility | 25 | $102.33 | $190.55 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $70.79 / $154.88
| Professional | | $40.74 | $70.79 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $54.95 / $85.11 / $177.83
| Professional | 25 | $54.95 | $85.11 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $75.86 / $125.89
| Professional | | $44.67 | $75.86 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $85.11 / $190.55
| Facility | | $70.79 | $85.11 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $74.13 / $138.04
| Professional | | $50.12 | $74.13 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Professional | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $93.33 / $181.97
| Professional | | $50.12 | $93.33 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $100.00 / $234.42
| Facility | | $64.57 | $100.00 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $102.33 / $190.55 / $204.17
| Facility | 25 | $102.33 | $190.55 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $70.79 / $144.54
| Professional | | $42.66 | $70.79 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $56.23 / $93.33 / $177.83
| Professional | 25 | $56.23 | $93.33 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $85.11 / $144.54
| Professional | | $50.12 | $85.11 | $144.54 |