- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.65 / $27.87 / $103.00
| Professional | | $21.65 | $27.87 | $103.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $10.96 / $13.02 / $14.17
| Professional | 52 | $10.96 | $13.02 | $14.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.25 / $31.71 / $34.51
| Professional | | $16.25 | $31.71 | $34.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $29.34 / $48.83
| Professional | | $19.05 | $29.34 | $48.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.04 / $36.58 / $52.62
| Professional | | $27.04 | $36.58 | $52.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.34 / $20.68 / $37.90
| Professional | | $13.34 | $20.68 | $37.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.08 / $40.35 / $44.84
| Professional | | $35.08 | $40.35 | $44.84 |