- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.56 / $21.07 / $61.72
| Facility | | $11.56 | $21.07 | $61.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.09 / $18.80 / $33.50
| Professional | | $11.09 | $18.80 | $33.50 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $73.78 / $73.78 / $73.78
| Professional | 50 | $73.78 | $73.78 | $73.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,723.00 / $3,373.00 / $4,707.00
| Facility | | $1,723.00 | $3,373.00 | $4,707.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.50 / $19.57 / $38.93
| Professional | | $12.50 | $19.57 | $38.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $16.92 / $28.26 / $46.42
| Professional | 50 | $16.92 | $28.26 | $46.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.83 / $50.00 / $56.00
| Facility | | $48.83 | $50.00 | $56.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.69 / $29.14 / $58.56
| Professional | | $14.69 | $29.14 | $58.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,158.00 / $2,720.00
| Facility | | $293.00 | $1,158.00 | $2,720.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.54 / $31.86 / $53.06
| Professional | | $17.54 | $31.86 | $53.06 |