- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.06 / $29.81 / $29.81
| Facility | | $27.06 | $29.81 | $29.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.75 / $24.61 / $31.69
| Professional | | $20.75 | $24.61 | $31.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.00 / $28.59 / $43.91
| Professional | | $18.00 | $28.59 | $43.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.93 / $32.34 / $52.34
| Professional | | $24.93 | $32.34 | $52.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.04 / $27.51 / $34.39
| Professional | | $21.04 | $27.51 | $34.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.14 / $24.64 / $36.71
| Professional | | $19.14 | $24.64 | $36.71 |