- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.79 / $28.41 / $38.85
| Professional | | $26.79 | $28.41 | $38.85 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $13.40 / $14.21 / $19.43
| Professional | 52 | $13.40 | $14.21 | $19.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.15 / $38.39 / $47.25
| Professional | | $34.15 | $38.39 | $47.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.70 / $42.92 / $47.25
| Professional | | $18.70 | $42.92 | $47.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.28 / $38.82 / $47.25
| Professional | | $24.28 | $38.82 | $47.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.30 / $32.11 / $131.13
| Professional | | $27.30 | $32.11 | $131.13 |