- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.77 / $25.77 / $28.62
| Facility | | $25.77 | $25.77 | $28.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.93 / $26.02 / $31.88
| Professional | | $21.93 | $26.02 | $31.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.69 / $24.87 / $41.32
| Professional | | $23.69 | $24.87 | $41.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $21.00 / $40.81
| Professional | | $17.00 | $21.00 | $40.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $25.97 / $46.35
| Professional | | $17.00 | $25.97 | $46.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.22 / $25.62 / $55.98
| Professional | | $19.22 | $25.62 | $55.98 |