- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $275.42 / $3,548.13
| Facility | | $102.33 | $275.42 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $346.74 / $812.83 / $4,677.35
| Facility | 25 | $346.74 | $812.83 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $165.96 / $831.76
| Professional | | $91.20 | $165.96 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $109.65 / $436.52 / $1,862.09
| Professional | 25 | $109.65 | $436.52 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $173.78 / $776.25
| Facility | | $131.83 | $173.78 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $128.82 / $229.09
| Professional | | $95.50 | $128.82 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $269.15 / $5,128.61
| Facility | | $165.96 | $269.15 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $144.54 / $281.84
| Professional | | $102.33 | $144.54 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $95.50 / $104.71
| Facility | | $85.11 | $95.50 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $125.89 / $218.78
| Professional | | $93.33 | $125.89 | $218.78 |