- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $131.83 / $234.42
| Facility | | $70.79 | $131.83 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $56.23 / $100.00
| Professional | | $32.36 | $56.23 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $38.02 / $67.61 / $107.15
| Professional | 25 | $38.02 | $67.61 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.89 / $58.88 / $79.43
| Professional | | $0.89 | $58.88 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $61.66 / $138.04
| Professional | | $35.48 | $61.66 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $79.43 / $100.00
| Professional | | $56.23 | $79.43 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $66.07 / $117.49
| Professional | | $52.48 | $66.07 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $109.65 / $234.42
| Facility | | $70.79 | $109.65 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $61.66 / $102.33
| Professional | | $33.88 | $61.66 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $45.71 / $67.61 / $107.15
| Professional | 25 | $45.71 | $67.61 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $57.54 / $97.72
| Professional | | $38.90 | $57.54 | $97.72 |