- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $125.89 / $141.25
| Facility | | $114.82 | $125.89 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $125.89 / $151.36
| Professional | | $100.00 | $125.89 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $123.03 / $138.04
| Professional | | $104.71 | $123.03 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $102.33 / $117.49 / $131.83
| Professional | 25 | $102.33 | $117.49 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.03
| Facility | | $0.02 | $0.02 | $0.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $134.90 / $169.82
| Professional | | $134.90 | $134.90 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $123.03 / $123.03
| Facility | | $39.81 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $138.04 / $223.87
| Professional | | $104.71 | $138.04 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $128.82 / $190.55
| Professional | | $85.11 | $128.82 | $190.55 |