- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.15 / $41.93 / $63.01
| Professional | | $36.15 | $41.93 | $63.01 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $18.07 / $19.93 / $31.51
| Professional | 52 | $18.07 | $19.93 | $31.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.08 / $71.69 / $84.59
| Professional | | $36.08 | $71.69 | $84.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.89 / $23.89 / $120.00
| Professional | | $23.89 | $23.89 | $120.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.97 / $32.65 / $86.01
| Professional | | $25.97 | $32.65 | $86.01 |