- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $1,543.03 / $3,955.04
| Facility | | $1,518.41 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.22 / $7.03 / $7.03
| Professional | | $2.22 | $7.03 | $7.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.36 / $10.86 / $20.12
| Facility | | $5.36 | $10.86 | $20.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.76 / $2.76 / $2.76
| Professional | | $2.76 | $2.76 | $2.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.22 / $7.96 / $9.18
| Facility | | $5.22 | $7.96 | $9.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $2.40 / $11.72
| Professional | | $1.70 | $2.40 | $11.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.50 / $3.00 / $11.27
| Professional | | $1.50 | $3.00 | $11.27 |