- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.41 / $40.27 / $48.15
| Professional | | $31.41 | $40.27 | $48.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $15.71 / $20.14 / $26.12
| Professional | 52 | $15.71 | $20.14 | $26.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.65 / $40.65 / $44.73
| Professional | | $40.65 | $40.65 | $44.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.06 / $39.42 / $115.75
| Professional | | $27.06 | $39.42 | $115.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.00 / $33.13 / $42.88
| Professional | | $26.00 | $33.13 | $42.88 |