- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.10 / $215.06 / $215.06
| Facility | | $2.10 | $215.06 | $215.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.10 / $2.10 / $2.54
| Professional | | $2.10 | $2.10 | $2.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.01 / $18.32 / $20.55
| Professional | | $15.01 | $18.32 | $20.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.38 / $9.47 / $11.72
| Professional | | $9.38 | $9.47 | $11.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.10 / $9.09 / $75.58
| Facility | | $2.10 | $9.09 | $75.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.26 / $3.56 / $10.91
| Professional | | $1.26 | $3.56 | $10.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.26 / $3.75 / $11.82
| Professional | | $1.26 | $3.75 | $11.82 |