- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.03 / $115.52 / $192.72
| Facility | | $91.03 | $115.52 | $192.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.05 / $15.47 / $17.52
| Professional | | $13.05 | $15.47 | $17.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.17 / $37.56 / $42.15
| Professional | | $28.17 | $37.56 | $42.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.48 / $21.69 / $27.27
| Professional | | $21.48 | $21.69 | $27.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.23 / $27.96 / $124.00
| Facility | | $13.23 | $27.96 | $124.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.83 / $18.64 / $31.69
| Professional | | $7.83 | $18.64 | $31.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.64 / $18.64 / $18.64
| Facility | | $18.64 | $18.64 | $18.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.83 / $9.51 / $27.03
| Professional | | $7.83 | $9.51 | $27.03 |