- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.97 / $38.75 / $54.29
| Professional | | $33.97 | $38.75 | $54.29 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $16.98 / $19.38 / $27.15
| Professional | 52 | $16.98 | $19.38 | $27.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.28 / $159.28 / $159.28
| Professional | | $159.28 | $159.28 | $159.28 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $39.82 / $39.82 / $39.82
| Professional | 52 | $39.82 | $39.82 | $39.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.53 / $53.98 / $87.75
| Professional | | $41.53 | $53.98 | $87.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.19 / $51.87 / $128.22
| Professional | | $35.19 | $51.87 | $128.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.60 / $59.77 / $150.71
| Professional | | $38.60 | $59.77 | $150.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.17 / $42.03 / $131.88
| Professional | | $29.17 | $42.03 | $131.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.10 / $35.95 / $55.14
| Professional | | $28.10 | $35.95 | $55.14 |