- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.45 / $239.91 / $484.91
| Professional | | $191.45 | $239.91 | $484.91 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $45.05 / $225.23 / $424.63
| Professional | 25 | $45.05 | $225.23 | $424.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.20 / $259.20 / $644.40
| Professional | | $259.20 | $259.20 | $644.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.26 / $302.48 / $674.21
| Professional | | $191.26 | $302.48 | $674.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.73 / $467.13 / $617.96
| Professional | | $281.73 | $467.13 | $617.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.36 / $294.91 / $641.10
| Professional | | $208.36 | $294.91 | $641.10 |