- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.09 / $133.93 / $213.43
| Facility | | $27.09 | $133.93 | $213.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.49 / $15.77 / $42.08
| Professional | | $12.49 | $15.77 | $42.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $24.21 / $62.41 / $90.00
| Professional | 50 | $24.21 | $62.41 | $90.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $7.13 / $7.13 / $7.83
| Professional | 52 | $7.13 | $7.13 | $7.83 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $2.85 / $2.85 / $3.13
| Professional | 53 | $2.85 | $2.85 | $3.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.23 / $33.82 / $39.86
| Professional | | $30.23 | $33.82 | $39.86 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $45.35 / $50.52 / $59.69
| Professional | 50 | $45.35 | $50.52 | $59.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.57 / $35.15 / $49.58
| Professional | | $18.57 | $35.15 | $49.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.25 / $14.82 / $176.02
| Facility | | $14.25 | $14.82 | $176.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.32 / $25.52 / $37.46
| Professional | | $14.32 | $25.52 | $37.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.44 / $28.40 / $37.46
| Professional | | $14.44 | $28.40 | $37.46 |