- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.24 / $70.00 / $167.21
| Facility | | $38.24 | $70.00 | $167.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.85 / $23.85 / $24.33
| Professional | | $23.85 | $23.85 | $24.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.79 / $34.25 / $47.38
| Facility | | $31.79 | $34.25 | $47.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.27 / $21.81 / $47.70
| Professional | | $15.27 | $21.81 | $47.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.52 / $59.80 / $105.13
| Facility | | $23.52 | $59.80 | $105.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.07 / $27.70 / $41.82
| Professional | | $18.07 | $27.70 | $41.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.55 / $16.82 / $46.21
| Professional | | $11.55 | $16.82 | $46.21 |