- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.54 / $26.06 / $34.32
| Professional | | $19.54 | $26.06 | $34.32 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $9.78 / $13.03 / $17.16
| Professional | 52 | $9.78 | $13.03 | $17.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.73 / $31.73 / $31.73
| Professional | | $31.73 | $31.73 | $31.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.62 / $35.77 / $37.04
| Professional | | $28.62 | $35.77 | $37.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.18 / $29.81 / $38.95
| Professional | | $18.18 | $29.81 | $38.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.75 / $19.34 / $30.45
| Professional | | $14.75 | $19.34 | $30.45 |