- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $204.17 / $457.09
| Facility | | $128.82 | $204.17 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $162.18 / $363.08 / $1,047.13
| Facility | 25 | $162.18 | $363.08 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $229.09 / $588.84
| Professional | | $141.25 | $229.09 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $169.82 / $316.23 / $707.95
| Professional | 25 | $169.82 | $316.23 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $213.80 / $239.88
| Facility | | $173.78 | $213.80 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $186.21 / $331.13
| Professional | | $1.00 | $186.21 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $173.78 / $288.40
| Facility | | $114.82 | $173.78 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $229.09 / $436.52
| Professional | | $162.18 | $229.09 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $169.82 / $213.80
| Facility | | $120.23 | $169.82 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $204.17 / $346.74
| Professional | | $141.25 | $204.17 | $346.74 |