- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.34 / $102.17 / $119.42
| Professional | | $72.34 | $102.17 | $119.42 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $99.43 / $99.43 / $99.43
| Professional | 25 | $99.43 | $99.43 | $99.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.96 / $95.96 / $95.96
| Facility | | $95.96 | $95.96 | $95.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.04 / $94.04 / $116.25
| Professional | | $94.04 | $94.04 | $116.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.76 / $109.66 / $163.41
| Professional | | $73.76 | $109.66 | $163.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.83 / $82.42 / $83.22
| Professional | | $80.83 | $82.42 | $83.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.14 / $103.54 / $155.63
| Professional | | $73.14 | $103.54 | $155.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.23 / $87.23 / $87.23
| Professional | | $87.23 | $87.23 | $87.23 |