- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.60 / $21.15 / $25.73
| Facility | | $19.60 | $21.15 | $25.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.57 / $20.42 / $32.66
| Professional | | $16.57 | $20.42 | $32.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.66 / $24.51 / $48.85
| Professional | | $10.66 | $24.51 | $48.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.10 / $35.10 / $35.10
| Facility | | $35.10 | $35.10 | $35.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.37 / $21.10 / $41.91
| Professional | | $11.37 | $21.10 | $41.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.54 / $26.62 / $51.40
| Professional | | $16.54 | $26.62 | $51.40 |