- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.38 / $66.12 / $140.80
| Facility | | $50.38 | $66.12 | $140.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.38 / $50.38 / $50.38
| Professional | | $50.38 | $50.38 | $50.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.35 / $3,005.27 / $4,782.47
| Facility | | $1,905.35 | $3,005.27 | $4,782.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.88 / $37.88 / $155.69
| Facility | | $37.88 | $37.88 | $155.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.38 / $50.38 / $52.90
| Facility | | $50.38 | $50.38 | $52.90 |