- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.71 / $15.79 / $19.53
| Professional | | $13.71 | $15.79 | $19.53 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $6.70 / $7.90 / $9.77
| Professional | 52 | $6.70 | $7.90 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.00 / $19.42 / $32.65
| Professional | | $16.00 | $19.42 | $32.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.67 / $18.05 / $35.88
| Professional | | $12.67 | $18.05 | $35.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.03 / $21.11 / $97.77
| Professional | | $13.03 | $21.11 | $97.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.18 / $17.98 / $33.78
| Professional | | $12.18 | $17.98 | $33.78 |