- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.01 / $2,922.09 / $4,511.85
| Facility | | $22.01 | $2,922.09 | $4,511.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.01 / $23.12 / $26.42
| Professional | | $22.01 | $23.12 | $26.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.46 / $20.46 / $20.46
| Facility | | $20.46 | $20.46 | $20.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.02 / $22.02 / $24.92
| Facility | | $22.02 | $22.02 | $24.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.02 / $22.02 / $22.02
| Professional | | $22.02 | $22.02 | $22.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.14 / $22.02 / $28.63
| Professional | | $21.14 | $22.02 | $28.63 |