- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.82 / $14.31 / $20.72
| Facility | | $8.82 | $14.31 | $20.72 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $172.56 / $172.56 / $209.04
| Facility | 25 | $172.56 | $172.56 | $209.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $15.16 / $22.65
| Professional | | $7.76 | $15.16 | $22.65 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $22.26 / $22.40 / $22.54
| Professional | 25 | $22.26 | $22.40 | $22.54 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $3.89 / $5.74 / $10.10
| Professional | 52 | $3.89 | $5.74 | $10.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.64 / $13.51 / $15.24
| Facility | | $11.64 | $13.51 | $15.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $16.66 / $27.21
| Professional | | $9.02 | $16.66 | $27.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.08 / $12.08 / $12.08
| Facility | | $12.08 | $12.08 | $12.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.77 / $15.77 / $15.77
| Professional | | $15.77 | $15.77 | $15.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.25 / $21.99 / $38.18
| Professional | | $16.25 | $21.99 | $38.18 |