- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.84 / $392.80 / $703.80
| Facility | | $25.84 | $392.80 | $703.80 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $5.34 / $5.34 / $18.64
| Facility | 52 | $5.34 | $5.34 | $18.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $34.85 / $60.88
| Professional | | $10.68 | $34.85 | $60.88 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $5.34 / $14.42 / $18.64
| Professional | 52 | $5.34 | $14.42 | $18.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.40 / $13.53 / $14.75
| Professional | | $12.40 | $13.53 | $14.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.60 / $41.60 / $108.40
| Professional | | $12.60 | $41.60 | $108.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.77 / $45.06 / $87.30
| Professional | | $32.77 | $45.06 | $87.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.96 / $68.81 / $97.84
| Professional | | $34.96 | $68.81 | $97.84 |