- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.93 / $338.84 / $1,905.46
| Facility | | $0.93 | $338.84 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $69.18 / $138.04
| Professional | | $34.67 | $69.18 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $75.86 / $144.54 / $245.47
| Professional | 50 | $75.86 | $144.54 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $61.66 / $102.33
| Professional | | $40.74 | $61.66 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $60.26 / $91.20 / $154.88
| Professional | 50 | $60.26 | $91.20 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $67.61 / $109.65
| Professional | | $44.67 | $67.61 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $69.18 / $123.03
| Professional | | $38.90 | $69.18 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.93 / $338.84 / $1,905.46
| Facility | | $0.93 | $338.84 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $63.10 / $134.90
| Professional | | $36.31 | $63.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $75.86 / $144.54 / $234.42
| Professional | 50 | $75.86 | $144.54 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $56.23 / $109.65
| Professional | | $35.48 | $56.23 | $109.65 |