- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.78 / $190.82 / $247.22
| Facility | | $139.78 | $190.82 | $247.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.59 / $128.81 / $272.68
| Professional | | $104.59 | $128.81 | $272.68 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $103.04 / $104.27 / $180.60
| Professional | 25 | $103.04 | $104.27 | $180.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.57 / $137.51 / $181.89
| Facility | | $119.57 | $137.51 | $181.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.57 / $179.36 / $281.14
| Professional | | $119.57 | $179.36 | $281.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.59 / $146.59 / $146.59
| Facility | | $146.59 | $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
- $102.84 / $112.98 / $172.48
| Professional | | $102.84 | $112.98 | $172.48 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $111.63 / $114.33 / $175.61
| Professional | 25 | $111.63 | $114.33 | $175.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.62 / $125.96 / $191.31
| Professional | | $87.62 | $125.96 | $191.31 |