- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $120.23 / $346.74
| Facility | | $61.66 | $120.23 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $70.79 / $234.42 / $588.84
| Facility | 25 | $70.79 | $234.42 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $120.23 / $288.40
| Professional | | $58.88 | $120.23 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $60.26 / $125.89 / $316.23
| Professional | 25 | $60.26 | $125.89 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $95.50 / $95.50 / $309.03
| Professional | 50 | $95.50 | $95.50 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.44 / $89.13 / $100.00
| Facility | | $72.44 | $89.13 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $93.33 / $173.78
| Professional | | $1.00 | $93.33 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $75.86 / $75.86 / $75.86
| Professional | 25 | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $251.19
| Facility | | $109.65 | $151.36 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $123.03 / $239.88
| Professional | | $77.62 | $123.03 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $75.86 / $114.82
| Facility | | $60.26 | $75.86 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $102.33 / $177.83
| Professional | | $67.61 | $102.33 | $177.83 |