- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.54 / $912.01 / $1,412.54
| Facility | | $57.54 | $912.01 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $309.03 / $954.99 / $1,202.26
| Facility | 25 | $309.03 | $954.99 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $67.61 / $194.98
| Professional | | $51.29 | $67.61 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $63.10 / $128.82 / $275.42
| Professional | 25 | $63.10 | $128.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $89.13 / $173.78
| Professional | | $67.61 | $89.13 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $117.49
| Professional | | $32.36 | $33.11 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $128.82 / $169.82
| Professional | | $97.72 | $128.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $144.54 / $181.97
| Professional | | $67.61 | $144.54 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $100.00 / $169.82
| Professional | | $77.62 | $100.00 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $74.13 / $117.49
| Professional | | $57.54 | $74.13 | $117.49 |