- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.53 / $36.04 / $47.11
| Professional | | $33.53 | $36.04 | $47.11 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $16.77 / $18.02 / $23.56
| Professional | 52 | $16.77 | $18.02 | $23.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.48 / $49.77 / $57.75
| Professional | | $41.48 | $49.77 | $57.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.73 / $51.55 / $57.75
| Professional | | $26.73 | $51.55 | $57.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $46.90 / $57.75
| Professional | | $32.36 | $46.90 | $57.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.31 / $39.06 / $159.26
| Professional | | $33.31 | $39.06 | $159.26 |