- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $12.02 / $20.89
| Professional | | $10.00 | $12.02 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,818.38 / $3,801.89
| Facility | | $2,344.23 | $2,818.38 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $16.22 / $19.05
| Professional | | $11.22 | $16.22 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $15.14 / $22.39
| Professional | | $11.22 | $15.14 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $588.84 / $1,548.82
| Facility | | $251.19 | $588.84 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.12 / $13.18 / $20.42
| Professional | | $9.12 | $13.18 | $20.42 |