- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.23 / $42.81 / $483.60
| Facility | | $27.23 | $42.81 | $483.60 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $172.05 / $460.20 / $508.30
| Facility | 25 | $172.05 | $460.20 | $508.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.41 / $40.28 / $65.36
| Professional | | $25.41 | $40.28 | $65.36 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $28.08 / $57.98 / $154.00
| Professional | 25 | $28.08 | $57.98 | $154.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.78 / $52.33 / $84.00
| Professional | | $32.78 | $52.33 | $84.00 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $41.65 / $51.30 / $62.49
| Professional | 25 | $41.65 | $51.30 | $62.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.22 / $40.54 / $110.72
| Facility | | $35.22 | $40.54 | $110.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.48 / $44.44 / $59.83
| Professional | | $28.48 | $44.44 | $59.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.73 / $42.26 / $42.26
| Facility | | $30.73 | $42.26 | $42.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.99 / $140.00 / $168.00
| Facility | | $46.99 | $140.00 | $168.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $29.37 / $29.37 / $29.37
| Facility | 62 | $29.37 | $29.37 | $29.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $4.70 / $4.70 / $4.70
| Facility | AS | $4.70 | $4.70 | $4.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.89 / $44.43 / $70.41
| Professional | | $28.89 | $44.43 | $70.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.15 / $46.19 / $70.06
| Professional | | $35.15 | $46.19 | $70.06 |