- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.85 / $21.30 / $179.92
| Facility | | $14.85 | $21.30 | $179.92 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $7.43 / $8.23 / $26.43
| Facility | 52 | $7.43 | $8.23 | $26.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.37 / $17.19 / $44.58
| Professional | | $13.37 | $17.19 | $44.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.47 / $17.59 / $21.04
| Professional | | $12.47 | $17.59 | $21.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.94 / $19.34 / $32.95
| Professional | | $14.94 | $19.34 | $32.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.89 / $20.22 / $38.46
| Professional | | $13.89 | $20.22 | $38.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.78 / $23.45 / $46.33
| Facility | | $13.78 | $23.45 | $46.33 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $26.62 / $52.73 / $52.73
| Facility | 52 | $26.62 | $52.73 | $52.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.02 / $25.21 / $250.96
| Professional | | $15.02 | $25.21 | $250.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.65 / $22.78 / $38.94
| Professional | | $14.65 | $22.78 | $38.94 |