- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.66 / $25.66 / $33.85
| Facility | | $25.66 | $25.66 | $33.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.85 / $28.35 / $35.75
| Professional | | $22.85 | $28.35 | $35.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.16 / $32.53 / $49.21
| Professional | | $23.16 | $32.53 | $49.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.40 / $40.19 / $71.81
| Professional | | $28.40 | $40.19 | $71.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.88 / $33.97 / $53.22
| Professional | | $24.88 | $33.97 | $53.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.71 / $30.30 / $36.83
| Professional | | $23.71 | $30.30 | $36.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.93 / $45.54 / $64.83
| Professional | | $27.93 | $45.54 | $64.83 |