- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.63 / $23.63 / $27.17
| Facility | | $23.63 | $23.63 | $27.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.64 / $26.27 / $29.56
| Professional | | $23.64 | $26.27 | $29.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.31 / $23.65 / $23.65
| Facility | | $22.31 | $23.65 | $23.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $23.65
| Professional | | $23.65 | $23.65 | $23.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.01 / $31.33 / $42.27
| Facility | | $26.01 | $31.33 | $42.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $29.56
| Professional | | $23.65 | $23.65 | $29.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.13 / $23.13 / $23.13
| Professional | | $23.13 | $23.13 | $23.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.02 / $34.38 / $57.30
| Facility | | $24.02 | $34.38 | $57.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.38 / $28.38 / $29.56
| Professional | | $28.38 | $28.38 | $29.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $23.65
| Professional | | $23.65 | $23.65 | $23.65 |