- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.10 / $33.64 / $45.65
| Professional | | $25.10 | $33.64 | $45.65 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $12.50 / $16.59 / $22.65
| Professional | 52 | $12.50 | $16.59 | $22.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.10 / $46.64 / $68.45
| Professional | | $27.10 | $46.64 | $68.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.34 / $34.95 / $54.92
| Professional | | $21.34 | $34.95 | $54.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.79 / $53.04 / $89.76
| Professional | | $40.79 | $53.04 | $89.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.42 / $33.75 / $58.74
| Professional | | $22.42 | $33.75 | $58.74 |