- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.26 / $25.35 / $40.10
| Professional | | $18.26 | $25.35 | $40.10 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $8.72 / $11.44 / $14.29
| Professional | 52 | $8.72 | $11.44 | $14.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.93 / $25.64 / $45.40
| Professional | | $24.93 | $25.64 | $45.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.77 / $30.07 / $60.15
| Professional | | $18.77 | $30.07 | $60.15 |
- 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
- $16.20 / $27.41 / $51.31
| Professional | | $16.20 | $27.41 | $51.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.82 / $28.58 / $45.00
| Facility | | $19.82 | $28.58 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.00 / $33.00 / $33.00
| Professional | | $33.00 | $33.00 | $33.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.52 / $32.58 / $43.89
| Professional | | $22.52 | $32.58 | $43.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.40 / $23.36 / $32.20
| Professional | | $13.40 | $23.36 | $32.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.65 / $100.65 / $100.65
| Facility | | $100.65 | $100.65 | $100.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.34 / $220.03 / $221.25
| Professional | | $126.34 | $220.03 | $221.25 |