- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.59 / $25.35 / $168.93
| Facility | | $24.59 | $25.35 | $168.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.19 / $23.31 / $31.53
| Professional | | $19.19 | $23.31 | $31.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.12 / $27.61 / $34.56
| Professional | | $22.12 | $27.61 | $34.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.22 / $39.61 / $87.13
| Professional | | $36.22 | $39.61 | $87.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.57 / $25.08 / $30.95
| Professional | | $22.57 | $25.08 | $30.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.32 / $22.40 / $34.15
| Professional | | $17.32 | $22.40 | $34.15 |