- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,204.06 / $3,204.06 / $3,204.06
| Facility | | $3,204.06 | $3,204.06 | $3,204.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.20 / $3.32 / $8.00
| Professional | | $1.20 | $3.32 | $8.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.99 / $5.25 / $6.56
| Professional | | $4.99 | $5.25 | $6.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.72 / $4.66 / $7.93
| Professional | | $3.72 | $4.66 | $7.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.99 / $4.75 / $6.76
| Facility | | $2.99 | $4.75 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.12 / $2.80 / $11.30
| Professional | | $2.12 | $2.80 | $11.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.00 / $4.82 / $6.31
| Facility | | $4.00 | $4.82 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.79 / $5.01 / $6.31
| Professional | | $3.79 | $5.01 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $6.40 / $8.60
| Professional | | $5.50 | $6.40 | $8.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $2.18 / $3.75
| Professional | | $2.02 | $2.18 | $3.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.94 / $3.94 / $3.94
| Facility | | $3.94 | $3.94 | $3.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.11 / $3.94 / $3.94
| Professional | | $3.11 | $3.94 | $3.94 |