- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.08 / $211.11 / $719.40
| Facility | | $33.08 | $211.11 | $719.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.82 / $12.32 / $57.22
| Professional | | $10.82 | $12.32 | $57.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $11.54 / $28.86
| Professional | | $10.74 | $11.54 | $28.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.08 / $21.03 / $22.29
| Professional | | $10.08 | $21.03 | $22.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.63 / $11.55 / $18.11
| Professional | | $9.63 | $11.55 | $18.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.05 / $12.59 / $22.66
| Professional | | $0.05 | $12.59 | $22.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.05 / $12.59 / $18.89
| Professional | | $0.05 | $12.59 | $18.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.92 / $13.31 / $23.41
| Professional | | $9.92 | $13.31 | $23.41 |