- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.57 / $19.18 / $37.29
| Facility | | $17.57 | $19.18 | $37.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.17 / $50.00 / $59.55
| Facility | | $2.17 | $50.00 | $59.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.93 / $21.17 / $115.39
| Professional | | $16.93 | $21.17 | $115.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $32.58 / $693.16
| Facility | | $32.36 | $32.58 | $693.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.83 / $9.27 / $20.72
| Professional | | $6.83 | $9.27 | $20.72 |