- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.20 / $15.10 / $21.38
| Professional | | $13.20 | $15.10 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $6.60 / $7.47 / $10.69
| Professional | 52 | $6.60 | $7.47 | $10.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.58 / $17.88 / $30.88
| Professional | | $12.58 | $17.88 | $30.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $17.98 / $21.92
| Professional | | $16.98 | $17.98 | $21.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.12 / $14.48 / $20.13
| Professional | | $12.12 | $14.48 | $20.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.17 / $12.90 / $24.75
| Professional | | $10.17 | $12.90 | $24.75 |