- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $104.71 / $213.80
| Facility | | $81.28 | $104.71 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $19.05 / $229.09 / $2,630.27
| Facility | 25 | $19.05 | $229.09 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $112.20 / $275.42
| Professional | | $77.62 | $112.20 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $131.83 / $331.13
| Facility | | $104.71 | $131.83 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $123.03 / $213.80
| Professional | | $79.43 | $123.03 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $346.74 / $1,000.00
| Facility | | $177.83 | $346.74 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $147.91 / $316.23
| Professional | | $100.00 | $147.91 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $95.50 / $123.03
| Facility | | $91.20 | $95.50 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $120.23 / $218.78
| Professional | | $87.10 | $120.23 | $218.78 |