- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.22 / $49.73 / $57.05
| Facility | | $23.22 | $49.73 | $57.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.50 / $23.21 / $25.54
| Professional | | $12.50 | $23.21 | $25.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.73 / $22.11 / $22.31
| Professional | | $18.73 | $22.11 | $22.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.76 / $22.95 / $28.45
| Professional | | $22.76 | $22.95 | $28.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.69 / $23.53 / $39.47
| Facility | | $17.69 | $23.53 | $39.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.07 / $22.96 / $25.14
| Professional | | $21.07 | $22.96 | $25.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.87 / $22.96 / $23.58
| Professional | | $20.87 | $22.96 | $23.58 |