- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.10 / $27.16 / $103.97
| Facility | | $24.10 | $27.16 | $103.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $25.54 / $33.11
| Professional | | $23.65 | $25.54 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.66 / $26.44 / $27.83
| Facility | | $23.66 | $26.44 | $27.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.43 / $24.43 / $24.43
| Professional | | $24.43 | $24.43 | $24.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.31 / $22.31 / $23.65
| Facility | | $22.31 | $22.31 | $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
- $23.63 / $25.72 / $35.95
| Facility | | $23.63 | $25.72 | $35.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.13 / $23.63 / $26.08
| Professional | | $23.13 | $23.63 | $26.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $23.65
| Facility | | $23.65 | $23.65 | $23.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $27.84
| Professional | | $23.65 | $23.65 | $27.84 |