- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.54 / $48.90 / $67.43
| Professional | | $33.54 | $48.90 | $67.43 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $16.78 / $20.97 / $33.72
| Professional | 52 | $16.78 | $20.97 | $33.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.00 / $84.00 / $84.00
| Professional | | $84.00 | $84.00 | $84.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.52 / $86.52 / $140.00
| Professional | | $86.52 | $86.52 | $140.00 |
- 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
- $29.71 / $45.25 / $112.54
| Professional | | $29.71 | $45.25 | $112.54 |