- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.84 / $174.67 / $267.66
| Professional | | $131.84 | $174.67 | $267.66 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $246.00 / $260.77 / $677.00
| Professional | 25 | $246.00 | $260.77 | $677.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.10 / $257.72 / $384.07
| Professional | | $134.10 | $257.72 | $384.07 |
- 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
- $194.09 / $272.42 / $391.88
| Professional | | $194.09 | $272.42 | $391.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.22 / $170.22 / $170.22
| Professional | | $170.22 | $170.22 | $170.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.21 / $226.57 / $351.41
| Professional | | $157.21 | $226.57 | $351.41 |