- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $380.19 / $1,778.28
| Facility | | $354.81 | $380.19 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $131.83 / $269.15 / $1,737.80
| Facility | 25 | $131.83 | $269.15 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $50.12 / $295.12
| Professional | | $30.20 | $50.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $47.86 / $81.28
| Professional | | $33.88 | $47.86 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $41.69 / $46.77
| Professional | | $41.69 | $41.69 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $45.71 / $72.44
| Professional | | $34.67 | $45.71 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $40.74 / $57.54
| Professional | | $33.11 | $40.74 | $57.54 |