- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.13 / $32.24 / $36.77
| Professional | | $28.13 | $32.24 | $36.77 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $14.07 / $16.12 / $17.32
| Professional | 52 | $14.07 | $16.12 | $17.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.79 / $30.88 / $46.19
| Professional | | $21.79 | $30.88 | $46.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.04 / $41.86 / $49.75
| Professional | | $38.04 | $41.86 | $49.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.45 / $27.47 / $72.14
| Professional | | $20.45 | $27.47 | $72.14 |