- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.22 / $44.09 / $135.94
| Professional | | $33.22 | $44.09 | $135.94 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $17.75 / $20.91 / $30.41
| Professional | 52 | $17.75 | $20.91 | $30.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.47 / $48.49 / $107.85
| Professional | | $35.47 | $48.49 | $107.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.20 / $203.25 / $320.82
| Professional | | $67.20 | $203.25 | $320.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.58 / $70.87 / $542.50
| Professional | | $36.58 | $70.87 | $542.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.59 / $58.85 / $101.61
| Professional | | $34.59 | $58.85 | $101.61 |