- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $28.84 / $457.09
| Facility | | $10.96 | $28.84 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $41.69 / $43.65
| Professional | | $12.88 | $41.69 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $32.36 / $36.31
| Professional | | $23.44 | $32.36 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $18.62 / $23.44
| Professional | | $18.62 | $18.62 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.22 / $33.88 / $100.00
| Facility | | $11.22 | $33.88 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $11.22 / $27.54
| Professional | | $6.76 | $11.22 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $16.22 / $27.54
| Professional | | $6.76 | $16.22 | $27.54 |