- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.79 / $42.49 / $121.44
| Facility | | $21.79 | $42.49 | $121.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $21.79 / $27.17
| Professional | | $17.78 | $21.79 | $27.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.81 / $24.37 / $42.10
| Professional | | $12.81 | $24.37 | $42.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.51 / $29.16 / $31.67
| Professional | | $21.51 | $29.16 | $31.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.12 / $23.92 / $36.52
| Professional | | $18.12 | $23.92 | $36.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.09 / $22.36 / $42.20
| Professional | | $12.09 | $22.36 | $42.20 |