- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.98 / $85.11 / $251.19
| Facility | | $16.98 | $85.11 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $45.71 / $100.00
| Professional | | $12.88 | $45.71 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $52.48 / $107.15
| Professional | | $17.38 | $52.48 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $26.30 / $79.43 / $158.49
| Professional | 50 | $26.30 | $79.43 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $47.86 / $141.25
| Professional | | $18.20 | $47.86 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $53.70 / $131.83
| Professional | | $16.98 | $53.70 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $72.44 / $245.47
| Facility | | $12.88 | $72.44 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $45.71 / $120.23
| Professional | | $14.13 | $45.71 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $47.86 / $117.49
| Professional | | $16.98 | $47.86 | $117.49 |