- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.86 / $17.72 / $334.95
| Facility | | $8.86 | $17.72 | $334.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $14.07 / $21.02
| Professional | | $7.76 | $14.07 | $21.02 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $3.74 / $5.51 / $10.10
| Professional | 52 | $3.74 | $5.51 | $10.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.34 / $10.34 / $10.34
| Facility | | $10.34 | $10.34 | $10.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.70 / $19.04 / $33.79
| Professional | | $10.70 | $19.04 | $33.79 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $10.10 / $17.18 / $30.70
| Facility | | $10.10 | $17.18 | $30.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.52 / $21.26 / $33.65
| Professional | | $11.52 | $21.26 | $33.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.00 / $26.69 / $39.76
| Professional | | $19.00 | $26.69 | $39.76 |