- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.90 / $115.55 / $150.87
| Professional | | $70.90 | $115.55 | $150.87 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $33.79 / $58.19 / $90.48
| Professional | 52 | $33.79 | $58.19 | $90.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.08 / $172.49 / $436.88
| Professional | | $142.08 | $172.49 | $436.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.79 / $123.84 / $332.07
| Professional | | $75.79 | $123.84 | $332.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.44 / $152.59 / $332.07
| Professional | | $96.44 | $152.59 | $332.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.61 / $159.44 / $463.52
| Professional | | $118.61 | $159.44 | $463.52 |