- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.10 / $626.42 / $690.84
| Facility | | $17.10 | $626.42 | $690.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.43 / $39.84 / $46.40
| Professional | | $12.43 | $39.84 | $46.40 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $5.57 / $7.90 / $22.22
| Professional | 52 | $5.57 | $7.90 | $22.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.07 / $35.08 / $59.06
| Professional | | $12.07 | $35.08 | $59.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.50 / $20.50 / $669.38
| Facility | | $20.50 | $20.50 | $669.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.96 / $46.07 / $91.32
| Professional | | $34.96 | $46.07 | $91.32 |