- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.88 / $165.09 / $622.27
| Facility | | $130.88 | $165.09 | $622.27 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $239.32 / $403.75 / $403.75
| Facility | 25 | $239.32 | $403.75 | $403.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.81 / $172.06 / $349.61
| Professional | | $108.81 | $172.06 | $349.61 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $98.82 / $175.13 / $338.33
| Professional | 25 | $98.82 | $175.13 | $338.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.92 / $376.14 / $377.60
| Facility | | $258.92 | $376.14 | $377.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.84 / $177.44 / $225.54
| Professional | | $131.84 | $177.44 | $225.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.00 / $173.00 / $335.00
| Facility | | $150.00 | $173.00 | $335.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.30 / $192.25 / $332.12
| Professional | | $127.30 | $192.25 | $332.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.96 / $188.54 / $276.19
| Professional | | $140.96 | $188.54 | $276.19 |