- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $36.31 / $89.13
| Professional | | $25.70 | $36.31 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $16.98 / $48.98 / $48.98
| Professional | 52 | $16.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $100.00 / $144.54
| Professional | | $56.23 | $100.00 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $93.33 / $158.49
| Professional | | $38.90 | $93.33 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $102.33 / $138.04
| Professional | | $58.88 | $102.33 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $79.43 / $134.90
| Professional | | $28.84 | $79.43 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $38.90 / $52.48 / $69.18
| Professional | 52 | $38.90 | $52.48 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $46.77 / $102.33
| Professional | | $27.54 | $46.77 | $102.33 |