- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.81 / $15.61 / $19.21
| Professional | | $13.81 | $15.61 | $19.21 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $6.91 / $7.72 / $9.61
| Professional | 52 | $6.91 | $7.72 | $9.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.07 / $15.87 / $22.02
| Professional | | $13.07 | $15.87 | $22.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.05 / $16.55 / $21.36
| Professional | | $12.05 | $16.55 | $21.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.10 / $17.26 / $26.79
| Professional | | $0.10 | $17.26 | $26.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.95 / $18.35 / $30.60
| Professional | | $13.95 | $18.35 | $30.60 |