- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.89 / $33.18 / $48.26
| Professional | | $23.89 | $33.18 | $48.26 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $11.28 / $14.90 / $21.74
| Professional | 52 | $11.28 | $14.90 | $21.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.21 / $25.92 / $34.47
| Professional | | $24.21 | $25.92 | $34.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.82 / $34.82 / $45.71
| Professional | | $34.82 | $34.82 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.64 / $47.41 / $90.94
| Professional | | $36.64 | $47.41 | $90.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.71 / $39.56 / $109.41
| Professional | | $27.71 | $39.56 | $109.41 |