- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.99 / $161.40 / $574.00
| Professional | | $131.99 | $161.40 | $574.00 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $212.65 / $212.65 / $212.65
| Professional | 25 | $212.65 | $212.65 | $212.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.77 / $172.31 / $380.90
| Professional | | $140.77 | $172.31 | $380.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $155.59 / $189.74
| Professional | | $60.00 | $155.59 | $189.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.94 / $284.94 / $316.60
| Professional | | $284.94 | $284.94 | $316.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.00 / $177.10 / $278.29
| Professional | | $153.00 | $177.10 | $278.29 |