- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.53 / $38.75 / $54.29
| Professional | | $33.53 | $38.75 | $54.29 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $16.77 / $19.38 / $27.15
| Professional | 52 | $16.77 | $19.38 | $27.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.40 / $58.40 / $66.42
| Professional | | $58.40 | $58.40 | $66.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.71 / $76.29 / $78.62
| Professional | | $30.71 | $76.29 | $78.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.14 / $38.97 / $55.58
| Professional | | $28.14 | $38.97 | $55.58 |