- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.93 / $48.68 / $135.94
| Professional | | $35.93 | $48.68 | $135.94 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $17.97 / $19.94 / $31.25
| Professional | 52 | $17.97 | $19.94 | $31.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.76 / $46.97 / $82.77
| Professional | | $38.76 | $46.97 | $82.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.96 / $126.96 / $126.96
| Professional | | $126.96 | $126.96 | $126.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.14 / $60.23 / $125.64
| Professional | | $38.14 | $60.23 | $125.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.49 / $73.30 / $241.45
| Professional | | $40.49 | $73.30 | $241.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.47 / $39.31 / $55.91
| Professional | | $32.47 | $39.31 | $55.91 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $18.91 / $22.69 / $25.53
| Professional | 52 | $18.91 | $22.69 | $25.53 |