- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.76 / $65.45 / $104.05
| Facility | | $23.76 | $65.45 | $104.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.76 / $55.13 / $148.33
| Professional | | $23.76 | $55.13 | $148.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.59 / $69.12 / $135.05
| Professional | | $31.59 | $69.12 | $135.05 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $47.38 / $103.68 / $202.57
| Professional | 50 | $47.38 | $103.68 | $202.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.98 / $71.88 / $172.81
| Professional | | $31.98 | $71.88 | $172.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.61 / $93.20 / $184.61
| Professional | | $34.61 | $93.20 | $184.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.76 / $65.45 / $104.05
| Facility | | $23.76 | $65.45 | $104.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.76 / $58.67 / $140.07
| Professional | | $23.76 | $58.67 | $140.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.70 / $92.83 / $184.50
| Professional | | $63.70 | $92.83 | $184.50 |