- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.01 / $206.47 / $269.91
| Facility | | $52.01 | $206.47 | $269.91 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $195.00 / $286.00 / $313.97
| Facility | 25 | $195.00 | $286.00 | $313.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.64 / $186.21 / $491.00
| Professional | | $95.64 | $186.21 | $491.00 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $107.23 / $221.68 / $522.00
| Professional | 25 | $107.23 | $221.68 | $522.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.19 / $235.26 / $310.86
| Professional | | $130.19 | $235.26 | $310.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.94 / $192.10 / $258.67
| Facility | | $128.94 | $192.10 | $258.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.72 / $277.54 / $351.28
| Professional | | $196.72 | $277.54 | $351.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $152.00 / $321.32
| Professional | | $32.34 | $152.00 | $321.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.42 / $242.28 / $309.56
| Professional | | $181.42 | $242.28 | $309.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.06 / $193.16 / $260.39
| Professional | | $152.06 | $193.16 | $260.39 |