- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.98 / $130.91 / $34,838.43
| Facility | | $41.98 | $130.91 | $34,838.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.98 / $41.98 / $41.98
| Professional | | $41.98 | $41.98 | $41.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.97 / $63.33 / $107.08
| Professional | | $41.97 | $63.33 | $107.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.61 / $39.61 / $41.98
| Facility | | $39.61 | $39.61 | $41.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.68 / $35.68 / $41.98
| Professional | | $35.68 | $35.68 | $41.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.20 / $41.98 / $68.04
| Professional | | $38.20 | $41.98 | $68.04 |