- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $100.00 / $229.09
| Facility | | $56.23 | $100.00 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $10.96 / $32.36
| Professional | | $5.01 | $10.96 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $12.88 / $22.91
| Professional | | $8.32 | $12.88 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $12.59 / $19.05 / $33.88
| Professional | 50 | $12.59 | $19.05 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $16.60 / $31.62
| Professional | | $8.71 | $16.60 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $15.14 / $27.54
| Professional | | $8.32 | $15.14 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $100.00 / $229.09
| Facility | | $56.23 | $100.00 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.92 / $14.45 / $33.88
| Professional | | $6.92 | $14.45 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $14.79 / $24.55
| Professional | | $8.32 | $14.79 | $24.55 |