- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.42 / $51.40 / $59.81
| Facility | | $20.42 | $51.40 | $59.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.56 / $14.91 / $35.83
| Professional | | $10.56 | $14.91 | $35.83 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $19.30 / $40.61 / $54.00
| Professional | 25 | $19.30 | $40.61 | $54.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.83 / $18.87 / $30.50
| Professional | | $11.83 | $18.87 | $30.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.46 / $17.12 / $28.31
| Professional | | $13.46 | $17.12 | $28.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.91 / $21.26 / $29.21
| Professional | | $16.91 | $21.26 | $29.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $23.06 / $31.76
| Professional | | $17.05 | $23.06 | $31.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.22 / $20.17 / $30.62
| Professional | | $13.22 | $20.17 | $30.62 |