- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.61 / $61.56 / $131.40
| Facility | | $51.61 | $61.56 | $131.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.88 / $12.36 / $17.51
| Professional | | $11.88 | $12.36 | $17.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.43 / $28.57 / $32.07
| Professional | | $21.43 | $28.57 | $32.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.52 / $16.69 / $20.98
| Professional | | $16.52 | $16.69 | $20.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.07 / $29.79 / $100.00
| Facility | | $10.07 | $29.79 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.09 / $17.02 / $28.36
| Professional | | $7.09 | $17.02 | $28.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.96 / $9.92 / $24.31
| Professional | | $5.96 | $9.92 | $24.31 |