- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.22 / $22.22 / $40.56
| Facility | | $22.22 | $22.22 | $40.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.00 / $24.35 / $44.98
| Professional | | $16.00 | $24.35 | $44.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.58 / $29.97 / $56.23
| Professional | | $15.58 | $29.97 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.63 / $28.95 / $36.68
| Professional | | $22.63 | $28.95 | $36.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.53 / $31.87 / $51.09
| Professional | | $22.53 | $31.87 | $51.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.43 / $33.28 / $52.82
| Professional | | $29.43 | $33.28 | $52.82 |