- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.30 / $113.93 / $534.24
| Facility | | $21.30 | $113.93 | $534.24 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $5.87 / $11.79 / $31.91
| Facility | 52 | $5.87 | $11.79 | $31.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.73 / $32.92 / $64.72
| Professional | | $11.73 | $32.92 | $64.72 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $5.87 / $11.79 / $35.32
| Professional | 52 | $5.87 | $11.79 | $35.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.43 / $26.85 / $34.86
| Professional | | $13.43 | $26.85 | $34.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.00 / $13.00 / $13.00
| Professional | | $13.00 | $13.00 | $13.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.69 / $33.02 / $67.77
| Professional | | $13.69 | $33.02 | $67.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.02 / $32.34 / $32.34
| Professional | | $28.02 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.65 / $44.72 / $104.29
| Professional | | $34.65 | $44.72 | $104.29 |