- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.01 / $34.56 / $58.24
| Professional | | $28.01 | $34.56 | $58.24 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $14.01 / $16.38 / $22.65
| Professional | 52 | $14.01 | $16.38 | $22.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.80 / $50.87 / $50.87
| Professional | | $46.80 | $50.87 | $50.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.67 / $27.08 / $44.22
| Professional | | $18.67 | $27.08 | $44.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.98 / $36.67 / $101.39
| Professional | | $19.98 | $36.67 | $101.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.27 / $214.27 / $340.65
| Professional | | $214.27 | $214.27 | $340.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.27 / $28.61 / $45.36
| Professional | | $19.27 | $28.61 | $45.36 |