- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.15 / $32.40 / $54.66
| Facility | | $32.15 | $32.40 | $54.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $39.20
| Professional | | $32.15 | $32.15 | $39.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.40 / $37.90 / $64.30
| Facility | | $36.40 | $37.90 | $64.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $32.15
| Professional | | $32.15 | $32.15 | $32.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.15 / $35.36 / $51.44
| Facility | | $32.15 | $35.36 | $51.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $33.76 / $46.62
| Professional | | $32.15 | $33.76 | $46.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.15 / $32.38 / $32.38
| Facility | | $32.15 | $32.38 | $32.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $44.14
| Professional | | $32.15 | $32.15 | $44.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.38 / $32.40 / $42.09
| Professional | | $32.38 | $32.40 | $42.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $33.11
| Professional | | $32.15 | $32.15 | $33.11 |