- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.83 / $50.53 / $215.64
| Facility | | $12.83 | $50.53 | $215.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.83 / $40.15 / $109.81
| Professional | | $12.83 | $40.15 | $109.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.10 / $40.97 / $103.84
| Professional | | $17.10 | $40.97 | $103.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $25.65 / $61.45 / $155.76
| Professional | 50 | $25.65 | $61.45 | $155.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.73 / $47.81 / $136.59
| Professional | | $17.73 | $47.81 | $136.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.96 / $57.70 / $145.72
| Professional | | $18.96 | $57.70 | $145.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.83 / $71.80 / $243.10
| Facility | | $12.83 | $71.80 | $243.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.83 / $41.65 / $92.87
| Professional | | $12.83 | $41.65 | $92.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.43 / $67.44 / $141.76
| Professional | | $50.43 | $67.44 | $141.76 |