- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.06 / $102.23 / $129.52
| Facility | | $59.06 | $102.23 | $129.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.50 / $25.44 / $43.40
| Professional | | $18.50 | $25.44 | $43.40 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $8.88 / $11.76 / $15.89
| Professional | 52 | $8.88 | $11.76 | $15.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.47 / $20.47 / $20.47
| Facility | | $20.47 | $20.47 | $20.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.09 / $26.06 / $43.02
| Professional | | $19.09 | $26.06 | $43.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.38 / $32.38 / $32.38
| Facility | | $32.38 | $32.38 | $32.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.63 / $27.81 / $51.31
| Professional | | $17.63 | $27.81 | $51.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $32.43 / $32.43 / $32.43
| Professional | 50 | $32.43 | $32.43 | $32.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.84 / $51.84 / $51.84
| Facility | | $51.84 | $51.84 | $51.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $26.67 / $45.19
| Professional | | $21.38 | $26.67 | $45.19 |