- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $107.58 / $131.02
| Facility | | $33.88 | $107.58 | $131.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $37.64
| Professional | | $33.88 | $33.88 | $37.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $34.47 / $34.47
| Professional | | $33.88 | $34.47 | $34.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.96 / $31.96 / $33.88
| Facility | | $31.96 | $31.96 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $43.15
| Professional | | $33.88 | $33.88 | $43.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.80 / $33.88 / $40.54
| Professional | | $28.80 | $33.88 | $40.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $54.91
| Professional | | $33.88 | $33.88 | $54.91 |