- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.22 / $507.43 / $1,792.07
| Facility | | $459.22 | $507.43 | $1,792.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.20 / $5.84 / $8.76
| Professional | | $4.20 | $5.84 | $8.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.83 / $4.83 / $4.83
| Professional | | $4.83 | $4.83 | $4.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.52 / $3.87 / $3.87
| Professional | | $3.52 | $3.87 | $3.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.64 / $10.97 / $13.74
| Professional | | $8.64 | $10.97 | $13.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.89 / $4.30 / $6.65
| Professional | | $3.89 | $4.30 | $6.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.84 / $3.84 / $7.34
| Professional | | $3.84 | $3.84 | $7.34 |