- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.93 / $124.73 / $162.06
| Facility | | $107.93 | $124.73 | $162.06 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $370.34 / $370.34 / $370.34
| Facility | 25 | $370.34 | $370.34 | $370.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.94 / $148.02 / $215.75
| Professional | | $107.94 | $148.02 | $215.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.72 / $204.04 / $298.50
| Professional | | $135.72 | $204.04 | $298.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.03 / $226.35 / $359.77
| Professional | | $136.03 | $226.35 | $359.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.40 / $209.96 / $314.69
| Professional | | $145.40 | $209.96 | $314.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.73 / $125.93 / $186.85
| Facility | | $124.73 | $125.93 | $186.85 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $370.34 / $370.34 / $370.34
| Facility | 25 | $370.34 | $370.34 | $370.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.93 / $162.06 / $279.19
| Professional | | $107.93 | $162.06 | $279.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.35 / $227.30 / $293.93
| Professional | | $164.35 | $227.30 | $293.93 |