- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.03 / $53.64 / $86.14
| Professional | | $40.03 | $53.64 | $86.14 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $20.02 / $26.82 / $43.07
| Professional | 52 | $20.02 | $26.82 | $43.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.00 / $51.00 / $51.00
| Professional | | $51.00 | $51.00 | $51.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.59 / $49.57 / $83.56
| Professional | | $30.59 | $49.57 | $83.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.64 / $48.39 / $56.46
| Professional | | $37.64 | $48.39 | $56.46 |