- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.20 / $296.04 / $428.12
| Facility | | $41.20 | $296.04 | $428.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.65 / $41.06 / $153.08
| Professional | | $40.65 | $41.06 | $153.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.65 / $41.20 / $41.20
| Professional | | $40.65 | $41.20 | $41.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.65 / $40.65 / $47.94
| Professional | | $40.65 | $40.65 | $47.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.54 / $40.65 / $167.40
| Professional | | $34.54 | $40.65 | $167.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.65 / $40.65 / $61.48
| Professional | | $40.65 | $40.65 | $61.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.20 / $41.61 / $46.75
| Professional | | $41.20 | $41.61 | $46.75 |