- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.13 / $53.38 / $126.30
| Facility | | $13.13 | $53.38 | $126.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.72 / $16.11 / $16.71
| Professional | | $15.72 | $16.11 | $16.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.23 / $37.78 / $42.19
| Professional | | $28.23 | $37.78 | $42.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.48 / $21.69 / $27.27
| Professional | | $21.48 | $21.69 | $27.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.13 / $26.41 / $100.00
| Facility | | $13.13 | $26.41 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.30 / $22.50 / $32.15
| Professional | | $9.30 | $22.50 | $32.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.88 / $19.13 / $32.15
| Professional | | $7.88 | $19.13 | $32.15 |