- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.32 / $36.83 / $163.50
| Facility | | $14.32 | $36.83 | $163.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.32 / $14.32 / $19.23
| Professional | | $14.32 | $14.32 | $19.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.01 / $41.23 / $46.27
| Professional | | $34.01 | $41.23 | $46.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.54 / $23.78 / $29.90
| Professional | | $23.54 | $23.78 | $29.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.32 / $24.34 / $100.00
| Facility | | $14.32 | $24.34 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.31 / $12.60 / $34.78
| Professional | | $6.31 | $12.60 | $34.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.31 / $10.23 / $29.67
| Professional | | $6.31 | $10.23 | $29.67 |