- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $165.96 / $354.81
| Facility | | $107.15 | $165.96 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $56.23 / $288.40 / $562.34
| Facility | 25 | $56.23 | $288.40 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $169.82 / $380.19
| Professional | | $109.65 | $169.82 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $147.91 / $239.88 / $562.34
| Professional | 25 | $147.91 | $239.88 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $199.53 / $501.19
| Facility | | $158.49 | $199.53 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $165.96 / $309.03
| Professional | | $114.82 | $165.96 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $234.42 / $1,548.82
| Facility | | $141.25 | $234.42 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $223.87 / $478.63
| Professional | | $134.90 | $223.87 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $194.98 / $426.58
| Facility | | $141.25 | $194.98 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $181.97 / $316.23
| Professional | | $114.82 | $181.97 | $316.23 |