- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $45.71 / $61.66
| Professional | | $45.71 | $45.71 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $407.38 / $1,096.48
| Facility | | $338.84 | $407.38 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.85 / $7.41 / $10.72
| Professional | | $0.85 | $7.41 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Facility | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.24 / $3.24 / $3.24
| Professional | | $3.24 | $3.24 | $3.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $60.26 / $61.66
| Professional | | $45.71 | $60.26 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Professional | | $257.04 | $257.04 | $257.04 |