- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.15 / $101.09 / $123.12
| Facility | | $32.15 | $101.09 | $123.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.14 / $32.15 / $32.47
| Professional | | $32.14 | $32.15 | $32.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.39 / $37.89
| Professional | | $32.15 | $32.39 | $37.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.33 / $30.33 / $32.15
| Facility | | $30.33 | $30.33 | $32.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $40.94
| Professional | | $32.15 | $32.15 | $40.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.33 / $29.71 / $33.43
| Professional | | $27.33 | $29.71 | $33.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $52.11
| Professional | | $32.15 | $32.15 | $52.11 |