- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $83.18 / $138.04
| Facility | | $83.18 | $83.18 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $70.79 / $107.15
| Professional | | $60.26 | $70.79 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $229.09 / $229.09 / $229.09
| Professional | 25 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $181.97 / $478.63
| Facility | | $81.28 | $181.97 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $107.15 / $245.47
| Professional | | $63.10 | $107.15 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $85.11 / $194.98
| Facility | | $85.11 | $85.11 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $93.33 / $147.91
| Professional | | $72.44 | $93.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $141.25 / $213.80
| Professional | | $83.18 | $141.25 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $104.71 / $7,079.46
| Facility | | $66.07 | $104.71 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $100.00 / $154.88
| Professional | | $56.23 | $100.00 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $107.15 / $190.55
| Professional | | $70.79 | $107.15 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $181.97 / $478.63
| Facility | | $81.28 | $181.97 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $107.15 / $245.47
| Professional | | $63.10 | $107.15 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $89.13 / $89.13
| Facility | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $117.49 / $234.42
| Professional | | $89.13 | $117.49 | $234.42 |