- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.16 / $98.14 / $164.56
| Facility | | $72.16 | $98.14 | $164.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.13 / $13.55 / $19.80
| Professional | | $11.13 | $13.55 | $19.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.66 / $30.33 / $33.86
| Professional | | $22.66 | $30.33 | $33.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.35 / $17.52 / $22.03
| Professional | | $17.35 | $17.52 | $22.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.92 / $66.56 / $100.00
| Facility | | $17.92 | $66.56 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.53 / $16.52 / $48.60
| Professional | | $7.53 | $16.52 | $48.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $16.52 / $25.81
| Professional | | $9.02 | $16.52 | $25.81 |