- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.74 / $179.74 / $269.95
| Facility | | $179.74 | $179.74 | $269.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.01 / $230.60 / $335.00
| Professional | | $158.01 | $230.60 | $335.00 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $246.91 / $463.84 / $463.84
| Professional | 25 | $246.91 | $463.84 | $463.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.04 / $178.99 / $227.35
| Professional | | $170.04 | $178.99 | $227.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.97 / $269.18 / $639.78
| Professional | | $160.97 | $269.18 | $639.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.58 / $231.23 / $642.50
| Professional | | $160.58 | $231.23 | $642.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.04 / $501.89 / $678.23
| Professional | | $187.04 | $501.89 | $678.23 |