- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.06 / $35.47 / $49.40
| Professional | | $32.06 | $35.47 | $49.40 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $16.03 / $17.73 / $24.70
| Professional | 52 | $16.03 | $17.73 | $24.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.80 / $40.24 / $54.21
| Professional | | $19.80 | $40.24 | $54.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.25 / $39.75 / $51.84
| Facility | | $10.25 | $39.75 | $51.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.25 / $43.20 / $54.00
| Professional | | $10.25 | $43.20 | $54.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.11 / $53.11 / $53.11
| Facility | | $53.11 | $53.11 | $53.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.04 / $44.01 / $77.43
| Professional | | $32.04 | $44.01 | $77.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.08 / $49.78 / $67.20
| Professional | | $39.08 | $49.78 | $67.20 |