- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.61 / $68.50 / $92.30
| Facility | | $23.61 | $68.50 | $92.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.61 / $23.61 / $23.61
| Professional | | $23.61 | $23.61 | $23.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.61 / $47.54 / $80.38
| Professional | | $23.61 | $47.54 | $80.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.27 / $22.27 / $23.61
| Facility | | $22.27 | $22.27 | $23.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.07 / $20.07 / $23.61
| Professional | | $20.07 | $20.07 | $23.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.61 / $23.61 / $38.27
| Professional | | $23.61 | $23.61 | $38.27 |