- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.38 / $96.00 / $159.61
| Facility | | $48.38 | $96.00 | $159.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.61 / $16.37 / $22.07
| Professional | | $13.61 | $16.37 | $22.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.71 / $19.20 / $102.00
| Facility | | $15.71 | $19.20 | $102.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.53 / $21.06 / $26.33
| Professional | | $11.53 | $21.06 | $26.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.39 / $21.15 / $82.78
| Facility | | $18.39 | $21.15 | $82.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.08 / $14.93 / $21.15
| Professional | | $14.08 | $14.93 | $21.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.72 / $10.87 / $11.03
| Professional | | $7.72 | $10.87 | $11.03 |