- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $33.88 / $53.70
| Professional | | $25.12 | $33.88 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $81.28 / $81.28 / $81.28
| Professional | 52 | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $40.74 / $83.18
| Professional | | $27.54 | $40.74 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $28.84 / $28.84
| Professional | | $28.84 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $38.02 / $46.77
| Professional | | $25.12 | $38.02 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $28.84 / $34.67
| Professional | | $20.89 | $28.84 | $34.67 |