- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.47 / $43.96 / $78.61
| Facility | | $34.47 | $43.96 | $78.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $34.82 / $2,283.78
| Professional | | $33.88 | $34.82 | $2,283.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $54.16 / $107.72
| Facility | | $33.88 | $54.16 | $107.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $36.97
| Professional | | $33.88 | $33.88 | $36.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.96 / $33.88 / $33.88
| Facility | | $31.96 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $35.15
| Professional | | $33.88 | $33.88 | $35.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $38.29
| Professional | | $33.88 | $33.88 | $38.29 |