- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.73 / $93.64 / $171.76
| Professional | | $67.73 | $93.64 | $171.76 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $32.46 / $40.63 / $59.06
| Professional | 52 | $32.46 | $40.63 | $59.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.53 / $100.65 / $151.27
| Professional | | $76.53 | $100.65 | $151.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.37 / $108.70 / $197.04
| Professional | | $84.37 | $108.70 | $197.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.20 / $102.49 / $179.36
| Professional | | $73.20 | $102.49 | $179.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.08 / $112.32 / $158.97
| Professional | | $82.08 | $112.32 | $158.97 |