- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.38 / $101.26 / $149.40
| Facility | | $84.38 | $101.26 | $149.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.74 / $16.59 / $24.70
| Professional | | $13.74 | $16.59 | $24.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.08 / $37.44 / $42.02
| Professional | | $28.08 | $37.44 | $42.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.06 / $21.27 / $26.75
| Professional | | $21.06 | $21.27 | $26.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.19 / $42.14 / $100.00
| Facility | | $13.19 | $42.14 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.28 / $13.00 / $37.15
| Professional | | $9.28 | $13.00 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.80 / $13.00 / $31.86
| Professional | | $7.80 | $13.00 | $31.86 |