- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.15 / $52.62 / $78.93
| Facility | | $28.15 | $52.62 | $78.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.31 / $21.31 / $25.57
| Professional | | $21.31 | $21.31 | $25.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.05 / $21.05 / $21.05
| Facility | | $21.05 | $21.05 | $21.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.05 / $21.05 / $21.05
| Professional | | $21.05 | $21.05 | $21.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.99 / $30.47 / $39.84
| Facility | | $22.99 | $30.47 | $39.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.05 / $21.05 / $21.05
| Professional | | $21.05 | $21.05 | $21.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.05 / $21.05 / $21.05
| Professional | | $21.05 | $21.05 | $21.05 |