- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.64 / $28.38 / $6,110.33
| Facility | | $23.64 | $28.38 | $6,110.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $26.27 / $31.93
| Professional | | $23.65 | $26.27 | $31.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.57 / $19.57 / $19.57
| Facility | | $19.57 | $19.57 | $19.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $27.80
| Facility | | $23.65 | $23.65 | $27.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $23.65
| Professional | | $23.65 | $23.65 | $23.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.70 / $23.65 / $30.27
| Professional | | $22.70 | $23.65 | $30.27 |