- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.47 / $50.62 / $57.15
| Professional | | $35.47 | $50.62 | $57.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $17.73 / $25.31 / $28.58
| Professional | 52 | $17.73 | $25.31 | $28.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.67 / $37.26 / $44.71
| Professional | | $30.67 | $37.26 | $44.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.11 / $53.11 / $53.11
| Facility | | $53.11 | $53.11 | $53.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.45 / $47.66 / $119.16
| Professional | | $29.45 | $47.66 | $119.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.17 / $45.99 / $69.83
| Facility | | $32.17 | $45.99 | $69.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.00 / $44.00 / $67.00
| Professional | | $22.00 | $44.00 | $67.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.85 / $43.20 / $58.44
| Professional | | $22.85 | $43.20 | $58.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.60 / $160.60 / $160.60
| Facility | | $160.60 | $160.60 | $160.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.21 / $334.05 / $334.05
| Professional | | $195.21 | $334.05 | $334.05 |