- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.49 / $15.10 / $16.54
| Professional | | $12.49 | $15.10 | $16.54 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $6.25 / $7.55 / $8.09
| Professional | 52 | $6.25 | $7.55 | $8.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.07 / $17.00 / $22.60
| Professional | | $14.07 | $17.00 | $22.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.24 / $18.23 / $28.77
| Professional | | $12.24 | $18.23 | $28.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.37 / $14.68 / $21.30
| Professional | | $11.37 | $14.68 | $21.30 |