- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.32 / $53.40 / $53.40
| Professional | | $45.32 | $53.40 | $53.40 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $22.66 / $26.70 / $26.70
| Professional | 52 | $22.66 | $26.70 | $26.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.42 / $90.07 / $100.52
| Professional | | $73.42 | $90.07 | $100.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.09 / $58.62 / $103.29
| Professional | | $23.09 | $58.62 | $103.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.59 / $53.40 / $80.51
| Facility | | $32.59 | $53.40 | $80.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.39 / $80.66 / $334.05
| Professional | | $48.39 | $80.66 | $334.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.28 / $49.51 / $109.16
| Professional | | $36.28 | $49.51 | $109.16 |