- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $100.00 / $123.03
| Facility | | $60.26 | $100.00 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $100.00 / $117.49
| Professional | | $61.66 | $100.00 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.78 / $13.18 / $107.15
| Professional | | $0.78 | $13.18 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.22 / $16.22 / $16.22
| Facility | | $16.22 | $16.22 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $131.83 / $181.97
| Professional | | $10.23 | $131.83 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $15.49 / $21.88
| Facility | | $12.02 | $15.49 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $120.23 / $223.87
| Professional | | $67.61 | $120.23 | $223.87 |