- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.40 / $61.56 / $74.04
| Facility | | $32.40 | $61.56 | $74.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.14 / $32.15 / $35.36
| Professional | | $32.14 | $32.15 | $35.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.42 / $33.76 / $102.56
| Facility | | $29.42 | $33.76 | $102.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $33.61
| Professional | | $32.15 | $32.15 | $33.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $32.15
| Facility | | $32.15 | $32.15 | $32.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $32.15
| Professional | | $32.15 | $32.15 | $32.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.22 / $34.88 / $37.89
| Professional | | $32.22 | $34.88 | $37.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.00 / $36.00 / $36.00
| Facility | | $36.00 | $36.00 | $36.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $32.15
| Professional | | $32.15 | $32.15 | $32.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $32.15
| Professional | | $32.15 | $32.15 | $32.15 |