- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.97 / $28.25 / $53.75
| Facility | | $22.97 | $28.25 | $53.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.64 / $22.43 / $22.97
| Professional | | $18.64 | $22.43 | $22.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.78 / $22.97 / $29.72
| Facility | | $15.78 | $22.97 | $29.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.97 / $22.97 / $22.97
| Professional | | $22.97 | $22.97 | $22.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.91 / $18.94 / $36.46
| Facility | | $16.91 | $18.94 | $36.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.40 / $13.03 / $15.33
| Professional | | $12.40 | $13.03 | $15.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.52 / $22.52 / $27.02
| Professional | | $22.52 | $22.52 | $27.02 |