- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.17 / $129.80 / $401.42
| Facility | | $108.17 | $129.80 | $401.42 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $473.00 / $473.00 / $473.00
| Facility | 25 | $473.00 | $473.00 | $473.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.87 / $108.17 / $210.93
| Professional | | $91.87 | $108.17 | $210.93 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $104.49 / $130.07 / $207.69
| Professional | 25 | $104.49 | $130.07 | $207.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.47 / $145.79 / $248.61
| Professional | | $126.47 | $145.79 | $248.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.00 / $146.59 / $146.59
| Facility | | $90.00 | $146.59 | $146.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.36 / $116.36 / $116.36
| Professional | | $116.36 | $116.36 | $116.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.51 / $186.47 / $333.53
| Professional | | $158.51 | $186.47 | $333.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.17 / $129.80 / $401.42
| Facility | | $108.17 | $129.80 | $401.42 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $473.00 / $473.00 / $473.00
| Facility | 25 | $473.00 | $473.00 | $473.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.65 / $117.49 / $210.93
| Professional | | $105.65 | $117.49 | $210.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.80 / $160.81 / $264.00
| Professional | | $110.80 | $160.81 | $264.00 |