- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.00 / $188.65 / $303.83
| Facility | | $98.00 | $188.65 | $303.83 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $149.53 / $149.53 / $149.53
| Facility | 52 | $149.53 | $149.53 | $149.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.89 / $35.32 / $72.73
| Professional | | $30.89 | $35.32 | $72.73 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $15.45 / $17.11 / $19.89
| Professional | 52 | $15.45 | $17.11 | $19.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.59 / $40.17 / $55.37
| Professional | | $34.59 | $40.17 | $55.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.00 / $59.00 / $59.00
| Facility | | $59.00 | $59.00 | $59.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.86 / $47.67 / $80.08
| Professional | | $37.86 | $47.67 | $80.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.65 / $70.52 / $73.88
| Professional | | $54.65 | $70.52 | $73.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.70 / $44.65 / $59.81
| Professional | | $33.70 | $44.65 | $59.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.00 / $261.54 / $315.98
| Facility | | $98.00 | $261.54 | $315.98 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $149.53 / $149.53 / $149.53
| Facility | 52 | $149.53 | $149.53 | $149.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.21 / $39.79 / $79.59
| Professional | | $34.21 | $39.79 | $79.59 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $15.45 / $17.11 / $19.89
| Professional | 52 | $15.45 | $17.11 | $19.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.03 / $40.86 / $73.93
| Professional | | $32.03 | $40.86 | $73.93 |