- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.63 / $165.28 / $216.29
| Facility | | $159.63 | $165.28 | $216.29 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $193.30 / $343.72 / $343.72
| Facility | 25 | $193.30 | $343.72 | $343.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.72 / $165.24 / $270.08
| Professional | | $135.72 | $165.24 | $270.08 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $131.94 / $184.94 / $260.77
| Professional | 25 | $131.94 | $184.94 | $260.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.16 / $214.70 / $242.27
| Facility | | $191.16 | $214.70 | $242.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.81 / $185.55 / $299.32
| Professional | | $137.81 | $185.55 | $299.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.13 / $187.13 / $187.13
| Facility | | $187.13 | $187.13 | $187.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.60 / $147.60 / $147.60
| Professional | | $147.60 | $147.60 | $147.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.55 / $194.28 / $325.24
| Professional | | $151.55 | $194.28 | $325.24 |