- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.14 / $24.15 / $33.82
| Professional | | $21.14 | $24.15 | $33.82 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $10.57 / $12.08 / $16.91
| Professional | 52 | $10.57 | $12.08 | $16.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.61 / $36.61 / $41.25
| Professional | | $36.61 | $36.61 | $41.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.45 / $47.67 / $49.16
| Professional | | $17.45 | $47.67 | $49.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.39 / $23.55 / $34.45
| Professional | | $16.39 | $23.55 | $34.45 |