- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.31 / $46.47 / $118.36
| Facility | | $21.31 | $46.47 | $118.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.30 / $21.53 / $29.26
| Professional | | $21.30 | $21.53 | $29.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.87 / $26.64 / $63.88
| Facility | | $22.87 | $26.64 | $63.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.31 / $21.31 / $21.31
| Professional | | $21.31 | $21.31 | $21.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.11 / $21.31 / $21.31
| Facility | | $20.11 | $21.31 | $21.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.31 / $21.31 / $21.31
| Professional | | $21.31 | $21.31 | $21.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.31 / $21.31 / $23.05
| Professional | | $21.31 | $21.31 | $23.05 |