- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.20 / $54.14 / $192.00
| Professional | | $32.20 | $54.14 | $192.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $74.84 / $241.50 / $274.50
| Professional | 50 | $74.84 | $241.50 | $274.50 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $17.64 / $27.37 / $125.25
| Professional | 52 | $17.64 | $27.37 | $125.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.01 / $257.33 / $311.98
| Facility | | $85.01 | $257.33 | $311.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.59 / $84.40 / $171.62
| Professional | | $71.59 | $84.40 | $171.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.81 / $67.47 / $171.62
| Professional | | $35.81 | $67.47 | $171.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.84 / $72.50 / $171.62
| Professional | | $47.84 | $72.50 | $171.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.91 / $70.66 / $210.65
| Professional | | $61.91 | $70.66 | $210.65 |