- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.71 / $16.13 / $21.69
| Professional | | $13.71 | $16.13 | $21.69 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $6.86 / $8.07 / $10.85
| Professional | 52 | $6.86 | $8.07 | $10.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.00 / $24.00 / $26.40
| Professional | | $24.00 | $24.00 | $26.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.91 / $17.64 / $60.29
| Professional | | $10.91 | $17.64 | $60.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.37 / $13.80 / $18.35
| Professional | | $11.37 | $13.80 | $18.35 |