- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.30 / $50.63 / $97.41
| Facility | | $10.30 | $50.63 | $97.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.56 / $10.30 / $13.83
| Professional | | $9.56 | $10.30 | $13.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.23 / $29.64 / $33.27
| Professional | | $22.23 | $29.64 | $33.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.93 / $17.10 / $21.50
| Professional | | $16.93 | $17.10 | $21.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.30 / $22.07 / $100.00
| Facility | | $10.30 | $22.07 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.29 / $17.64 / $25.23
| Professional | | $7.29 | $17.64 | $25.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.18 / $10.29 / $25.23
| Professional | | $6.18 | $10.29 | $25.23 |