- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $56.23 / $501.19
| Facility | | $56.23 | $56.23 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $56.23 / $61.66
| Professional | | $30.20 | $56.23 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.24 / $3.24 / $3.24
| Professional | | $3.24 | $3.24 | $3.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $954.99 / $1,479.11
| Facility | | $602.56 | $954.99 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.43 / $0.50 / $0.50
| Professional | | $0.43 | $0.50 | $0.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $407.38 / $549.54
| Facility | | $263.03 | $407.38 | $549.54 |