- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.51 / $28.27 / $40.18
| Professional | | $16.51 | $28.27 | $40.18 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $10.55 / $14.14 / $20.09
| Professional | 52 | $10.55 | $14.14 | $20.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.45 / $21.71 / $27.36
| Professional | | $18.45 | $21.71 | $27.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.94 / $77.69 / $93.08
| Professional | | $16.94 | $77.69 | $93.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.34 / $33.47 / $55.96
| Professional | | $23.34 | $33.47 | $55.96 |