- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.84 / $121.61 / $157.53
| Facility | | $84.84 | $121.61 | $157.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.60 / $48.16 / $96.76
| Professional | | $28.60 | $48.16 | $96.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.20 / $57.42 / $87.88
| Professional | | $34.20 | $57.42 | $87.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $51.30 / $86.13 / $131.82
| Professional | 50 | $51.30 | $86.13 | $131.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.23 / $68.08 / $112.34
| Professional | | $41.23 | $68.08 | $112.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.81 / $71.31 / $120.06
| Professional | | $40.81 | $71.31 | $120.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.95 / $115.00 / $157.53
| Facility | | $29.95 | $115.00 | $157.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.60 / $48.57 / $96.76
| Professional | | $28.60 | $48.57 | $96.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.42 / $67.87 / $118.54
| Professional | | $49.42 | $67.87 | $118.54 |