- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.24 / $100.74 / $197.46
| Facility | | $43.24 | $100.74 | $197.46 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $35.72 / $59.78 / $228.71
| Facility | 25 | $35.72 | $59.78 | $228.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.65 / $108.13 / $235.00
| Professional | | $67.65 | $108.13 | $235.00 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $78.56 / $132.05 / $236.00
| Professional | 25 | $78.56 | $132.05 | $236.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.72 / $105.48 / $151.34
| Facility | | $91.72 | $105.48 | $151.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.76 / $178.14 / $275.36
| Professional | | $118.76 | $178.14 | $275.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.72 / $129.72 / $129.72
| Facility | | $129.72 | $129.72 | $129.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.45 / $124.61 / $219.62
| Professional | | $79.45 | $124.61 | $219.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.55 / $134.08 / $162.35
| Professional | | $105.55 | $134.08 | $162.35 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $102.38 / $139.22 / $216.07
| Professional | 25 | $102.38 | $139.22 | $216.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.75 / $104.11 / $179.54
| Professional | | $72.75 | $104.11 | $179.54 |