- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.43 / $114.00 / $243.74
| Professional | | $96.43 | $114.00 | $243.74 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $23.18 / $197.68 / $426.04
| Professional | 25 | $23.18 | $197.68 | $426.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.02 / $130.02 / $281.70
| Professional | | $130.02 | $130.02 | $281.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.32 / $139.52 / $290.48
| Professional | | $91.32 | $139.52 | $290.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.28 / $235.55 / $267.81
| Professional | | $121.28 | $235.55 | $267.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.26 / $129.03 / $280.50
| Professional | | $92.26 | $129.03 | $280.50 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $80.00 / $85.00 / $255.60
| Professional | 25 | $80.00 | $85.00 | $255.60 |