- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $154.88 / $251.19
| Facility | | $104.71 | $154.88 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $109.65 / $134.90 / $177.83
| Facility | 25 | $109.65 | $134.90 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $154.88 / $281.84
| Professional | | $107.15 | $154.88 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $104.71 / $218.78 / $346.74
| Professional | 25 | $104.71 | $218.78 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $190.55 / $213.80
| Facility | | $154.88 | $190.55 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $147.91 / $251.19
| Professional | | $93.33 | $147.91 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $199.53 / $588.84
| Facility | | $154.88 | $199.53 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $204.17
| Professional | | $147.91 | $147.91 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $186.21 / $537.03
| Facility | | $91.20 | $186.21 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $154.88 / $269.15
| Professional | | $102.33 | $154.88 | $269.15 |