- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.64 / $48.68 / $64.06
| Professional | | $33.64 | $48.68 | $64.06 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $16.82 / $24.34 / $32.04
| Professional | 52 | $16.82 | $24.34 | $32.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.36 / $40.38 / $71.84
| Professional | | $25.36 | $40.38 | $71.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.45 / $49.18 / $105.75
| Professional | | $29.45 | $49.18 | $105.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.21 / $334.05 / $334.05
| Professional | | $195.21 | $334.05 | $334.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.25 / $46.78 / $61.84
| Professional | | $31.25 | $46.78 | $61.84 |