- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.95 / $11,360.47 / $11,360.47
| Facility | | $18.95 | $11,360.47 | $11,360.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.01 / $22.23 / $24.46
| Professional | | $22.01 | $22.23 | $24.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.02 / $33.03 / $33.03
| Facility | | $22.02 | $33.03 | $33.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.77 / $22.02 / $34.44
| Facility | | $20.77 | $22.02 | $34.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.02 / $22.02 / $38.96
| Professional | | $22.02 | $22.02 | $38.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.02 / $22.02 / $43.83
| Professional | | $22.02 | $22.02 | $43.83 |