- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.37 / $100.15 / $117.82
| Facility | | $88.37 | $100.15 | $117.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.37 / $117.82 / $298.67
| Professional | | $88.37 | $117.82 | $298.67 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $26.28 / $26.28 / $147.68
| Professional | 25 | $26.28 | $26.28 | $147.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.97 / $203.27 / $272.66
| Professional | | $119.97 | $203.27 | $272.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.67 / $241.88 / $295.83
| Professional | | $236.67 | $241.88 | $295.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.13 / $278.02 / $601.01
| Facility | | $137.13 | $278.02 | $601.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.38 / $217.86 / $305.37
| Professional | | $149.38 | $217.86 | $305.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.83 / $247.93 / $252.54
| Facility | | $155.83 | $247.93 | $252.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.00 / $247.93 / $319.01
| Professional | | $143.00 | $247.93 | $319.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.88 / $242.76 / $305.37
| Professional | | $151.88 | $242.76 | $305.37 |