- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.74 / $114.38 / $139.31
| Facility | | $36.74 | $114.38 | $139.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.74 / $36.74 / $79.93
| Professional | | $36.74 | $36.74 | $79.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.67 / $36.67 / $42.89
| Professional | | $36.67 | $36.67 | $42.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.65 / $34.65 / $36.74
| Facility | | $34.65 | $34.65 | $36.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.74 / $36.74 / $46.80
| Professional | | $36.74 | $36.74 | $46.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.23 / $33.64 / $37.85
| Professional | | $31.23 | $33.64 | $37.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.74 / $40.90 / $54.08
| Professional | | $36.74 | $40.90 | $54.08 |