- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.82 / $14.60 / $16.51
| Professional | | $11.82 | $14.60 | $16.51 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $5.91 / $7.30 / $8.26
| Professional | 52 | $5.91 | $7.30 | $8.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.60 / $16.79 / $18.79
| Professional | | $14.60 | $16.79 | $18.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.26 / $16.55 / $39.19
| Professional | | $12.26 | $16.55 | $39.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.32 / $14.13 / $22.38
| Professional | | $10.32 | $14.13 | $22.38 |