- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.13 / $32.76 / $45.59
| Professional | | $28.13 | $32.76 | $45.59 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $14.07 / $16.38 / $22.80
| Professional | 52 | $14.07 | $16.38 | $22.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.32 / $48.32 / $55.44
| Professional | | $48.32 | $48.32 | $55.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.47 / $62.94 / $64.86
| Professional | | $20.47 | $62.94 | $64.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.76 / $30.05 / $45.80
| Professional | | $18.76 | $30.05 | $45.80 |