- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.35 / $22.35 / $26.20
| Facility | | $22.35 | $22.35 | $26.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.62 / $25.55 / $33.07
| Professional | | $13.62 | $25.55 | $33.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.94 / $25.20 / $33.97
| Professional | | $19.94 | $25.20 | $33.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.77 / $19.77 / $24.33
| Facility | | $19.77 | $19.77 | $24.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.11 / $15.83 / $47.87
| Professional | | $10.11 | $15.83 | $47.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.98 / $27.79 / $51.40
| Professional | | $15.98 | $27.79 | $51.40 |