- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.71 / $14.93 / $21.38
| Professional | | $13.71 | $14.93 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $6.86 / $7.47 / $10.69
| Professional | 52 | $6.86 | $7.47 | $10.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.92 / $17.92 / $27.76
| Professional | | $17.92 | $17.92 | $27.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.45 / $28.07 / $32.19
| Professional | | $17.45 | $28.07 | $32.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.80 / $16.37 / $22.75
| Professional | | $12.80 | $16.37 | $22.75 |