- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.65 / $434.39 / $915.72
| Facility | | $40.65 | $434.39 | $915.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.65 / $40.65 / $48.78
| Professional | | $40.65 | $40.65 | $48.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.72 / $40.65 / $46.23
| Facility | | $35.72 | $40.65 | $46.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.65 / $40.65 / $41.20
| Professional | | $40.65 | $40.65 | $41.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.19 / $44.10 / $44.10
| Professional | | $42.19 | $44.10 | $44.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.92 / $42.75 / $45.74
| Professional | | $36.92 | $42.75 | $45.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.65 / $40.65 / $48.78
| Professional | | $40.65 | $40.65 | $48.78 |