- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $3,981.07
| Facility | | $1,513.56 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $2.09 / $7.94
| Professional | | $1.00 | $2.09 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.69 / $3.24 / $4.47
| Facility | | $2.69 | $3.24 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.91 / $2.24 / $4.37
| Professional | | $1.91 | $2.24 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.25 / $8.32 / $9.12
| Facility | | $5.25 | $8.32 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $2.40 / $11.75
| Professional | | $1.70 | $2.40 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $11.22
| Facility | | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.51 / $3.02 / $11.22
| Professional | | $1.51 | $3.02 | $11.22 |