- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.52 / $93.64 / $158.62
| Professional | | $60.52 | $93.64 | $158.62 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $32.59 / $40.78 / $66.97
| Professional | 52 | $32.59 | $40.78 | $66.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.65 / $83.12 / $140.44
| Professional | | $70.65 | $83.12 | $140.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.00 / $154.00 / $154.00
| Professional | | $154.00 | $154.00 | $154.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.09 / $112.13 / $158.62
| Professional | | $77.09 | $112.13 | $158.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.68 / $87.66 / $208.15
| Professional | | $58.68 | $87.66 | $208.15 |