- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.07 / $62.64 / $67.50
| Facility | | $28.07 | $62.64 | $67.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.00 / $28.08 / $31.04
| Professional | | $27.00 | $28.08 | $31.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.13 / $32.79 / $85.56
| Facility | | $26.13 | $32.79 | $85.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.00 / $27.00 / $27.00
| Professional | | $27.00 | $27.00 | $27.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.00 / $27.00 / $27.00
| Facility | | $27.00 | $27.00 | $27.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.00 / $27.00 / $27.00
| Professional | | $27.00 | $27.00 | $27.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.00 / $27.00 / $32.70
| Professional | | $27.00 | $27.00 | $32.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.64 / $62.64 / $67.50
| Facility | | $62.64 | $62.64 | $67.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.26 / $29.53 / $39.96
| Professional | | $27.26 | $29.53 | $39.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.00 / $27.00 / $47.25
| Professional | | $27.00 | $27.00 | $47.25 |