- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.81 / $132.49 / $165.63
| Facility | | $119.81 | $132.49 | $165.63 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $140.51 / $147.86 / $147.86
| Facility | 25 | $140.51 | $147.86 | $147.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.15 / $139.66 / $215.63
| Professional | | $105.15 | $139.66 | $215.63 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $170.76 / $261.39 / $261.39
| Professional | 25 | $170.76 | $261.39 | $261.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.75 / $180.65 / $203.85
| Facility | | $152.75 | $180.65 | $203.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.76 / $161.74 / $266.77
| Professional | | $123.76 | $161.74 | $266.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.07 / $174.07 / $174.07
| Facility | | $174.07 | $174.07 | $174.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.90 / $147.90 / $147.90
| Professional | | $147.90 | $147.90 | $147.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.76 / $177.46 / $308.87
| Professional | | $114.76 | $177.46 | $308.87 |