- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.22 / $138.04 / $512.86
| Facility | | $11.22 | $138.04 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $24.55 / $426.58
| Professional | | $14.45 | $24.55 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $63.10 / $158.49
| Facility | | $50.12 | $63.10 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $1.00 / $63.10
| Professional | | $0.02 | $1.00 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.13 / $34.67 / $64.57
| Facility | | $14.13 | $34.67 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $5.25 / $5.25
| Professional | | $5.25 | $5.25 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $12.30 / $38.02
| Professional | | $11.75 | $12.30 | $38.02 |