- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.33 / $28.34 / $34.32
| Professional | | $25.33 | $28.34 | $34.32 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $12.67 / $14.17 / $17.16
| Professional | 52 | $12.67 | $14.17 | $17.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.25 / $31.71 / $34.51
| Professional | | $16.25 | $31.71 | $34.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.15 / $31.22 / $79.29
| Professional | | $22.15 | $31.22 | $79.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.08 / $35.08 / $35.08
| Professional | | $35.08 | $35.08 | $35.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.59 / $24.56 / $84.39
| Professional | | $13.59 | $24.56 | $84.39 |