- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $87.10 / $151.36
| Professional | | $72.44 | $87.10 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $1,548.82
| Facility | | $676.08 | $676.08 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $104.71 / $138.04
| Professional | | $61.66 | $104.71 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $91.20 / $91.20
| Facility | | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.62 / $31.62 / $31.62
| Facility | | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $75.86 / $245.47
| Professional | | $39.81 | $75.86 | $245.47 |