- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.33 / $5,651.31 / $5,976.15
| Facility | | $13.33 | $5,651.31 | $5,976.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.65 / $20.12
| Professional | | $10.54 | $10.65 | $20.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.55 / $12.13 / $12.13
| Professional | | $10.55 | $12.13 | $12.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.54 / $13.54 / $85.00
| Facility | | $13.54 | $13.54 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $13.43
| Professional | | $10.54 | $10.54 | $13.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.96 / $10.54 / $16.30
| Professional | | $8.96 | $10.54 | $16.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $11.73 / $12.79
| Professional | | $10.54 | $11.73 | $12.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.12 / $13.54 / $16.36
| Professional | | $12.12 | $13.54 | $16.36 |