- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.22 / $38.74 / $55.67
| Professional | | $28.22 | $38.74 | $55.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.00 / $27.85 / $44.47
| Professional | | $25.00 | $27.85 | $44.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.64 / $33.00 / $62.52
| Professional | | $28.64 | $33.00 | $62.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.56 / $36.91 / $54.84
| Professional | | $28.56 | $36.91 | $54.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.76 / $36.51 / $74.03
| Professional | | $25.76 | $36.51 | $74.03 |