- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.06 / $22.52 / $100.93
| Facility | | $22.06 | $22.52 | $100.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $22.06
| Professional | | $20.72 | $20.72 | $22.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.14 / $23.71 / $23.71
| Professional | | $20.14 | $23.71 | $23.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.54 / $19.54 / $19.54
| Facility | | $19.54 | $19.54 | $19.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $29.32
| Professional | | $20.72 | $20.72 | $29.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $20.72
| Professional | | $20.72 | $20.72 | $20.72 |