- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.22 / $15.30 / $19.12
| Professional | | $14.22 | $15.30 | $19.12 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $6.95 / $7.60 / $8.26
| Professional | 52 | $6.95 | $7.60 | $8.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.08 / $16.00 / $21.24
| Professional | | $13.08 | $16.00 | $21.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.62 / $19.50 / $31.34
| Professional | | $13.62 | $19.50 | $31.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.16 / $18.28 / $26.19
| Professional | | $12.16 | $18.28 | $26.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.63 / $32.34 / $32.34
| Professional | | $10.63 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.26 / $16.11 / $26.27
| Professional | | $12.26 | $16.11 | $26.27 |