- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.55 / $22.88 / $29.22
| Professional | | $18.55 | $22.88 | $29.22 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $9.27 / $11.44 / $14.61
| Professional | 52 | $9.27 | $11.44 | $14.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.41 / $22.70 / $31.42
| Professional | | $15.41 | $22.70 | $31.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.51 / $27.51 / $46.01
| Professional | | $27.51 | $27.51 | $46.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.98 / $22.83 / $29.97
| Professional | | $19.98 | $22.83 | $29.97 |