- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.34 / $12.34 / $14.04
| Facility | | $12.34 | $12.34 | $14.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.56 / $14.04 / $41.44
| Professional | | $10.56 | $14.04 | $41.44 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $13.96 / $49.00 / $51.88
| Professional | 25 | $13.96 | $49.00 | $51.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.00 / $16.87 / $27.05
| Professional | | $13.00 | $16.87 | $27.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.59 / $20.56 / $60.00
| Professional | | $16.59 | $20.56 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.35 / $18.44 / $25.82
| Professional | | $12.35 | $18.44 | $25.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.52 / $16.34 / $24.08
| Professional | | $12.52 | $16.34 | $24.08 |