- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.11 / $76.56 / $76.56
| Facility | | $14.11 | $76.56 | $76.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.05 / $13.77 / $14.11
| Professional | | $12.05 | $13.77 | $14.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.50 / $7.65 / $7.65
| Professional | | $6.50 | $7.65 | $7.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.65 / $225.88 / $542.12
| Facility | | $20.65 | $225.88 | $542.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.79 / $24.09 / $317.88
| Professional | | $19.79 | $24.09 | $317.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.19 / $13.39 / $22.72
| Facility | | $11.19 | $13.39 | $22.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.02 / $82.95 / $82.95
| Professional | | $20.02 | $82.95 | $82.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.45 / $10.33 / $17.21
| Professional | | $7.45 | $10.33 | $17.21 |