- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $79.43 / $123.03
| Facility | | $70.79 | $79.43 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $97.72 / $181.97
| Professional | | $72.44 | $97.72 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Professional | 25 | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $134.90 / $169.82
| Professional | | $74.13 | $134.90 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $151.36 / $229.09
| Professional | | $85.11 | $151.36 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $141.25 / $165.96
| Professional | | $120.23 | $141.25 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $79.43 / $123.03
| Facility | | $70.79 | $79.43 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $95.50 / $181.97
| Professional | | $72.44 | $95.50 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Professional | 25 | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $131.83 / $169.82
| Professional | | $85.11 | $131.83 | $169.82 |