- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.50 / $34.65 / $51.06
| Professional | | $26.50 | $34.65 | $51.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.13 / $37.89 / $56.21
| Professional | | $26.13 | $37.89 | $56.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $52.75 / $57.12
| Professional | | $32.34 | $52.75 | $57.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.22 / $37.89 / $56.21
| Professional | | $26.22 | $37.89 | $56.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.60 / $36.63 / $59.40
| Professional | | $25.60 | $36.63 | $59.40 |