- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $29.24 / $35.97
| Professional | | $27.86 | $29.24 | $35.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.63 / $24.87 / $24.87
| Facility | | $23.63 | $24.87 | $24.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.62 / $24.62 / $24.62
| Professional | | $24.62 | $24.62 | $24.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.86 / $29.24 / $35.97
| Facility | | $27.86 | $29.24 | $35.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.48 / $30.46 / $30.46
| Professional | | $29.48 | $30.46 | $30.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.07 / $30.46 / $30.46
| Professional | | $30.07 | $30.46 | $30.46 |