- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.07 / $50.63 / $75.00
| Facility | | $17.07 | $50.63 | $75.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.56 / $16.11 / $17.00
| Professional | | $12.56 | $16.11 | $17.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.02 / $13.02 / $13.02
| Professional | | $13.02 | $13.02 | $13.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.49 / $41.26 / $68.62
| Facility | | $10.49 | $41.26 | $68.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.86 / $15.80 / $22.52
| Professional | | $10.86 | $15.80 | $22.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.13 / $30.48 / $54.86
| Facility | | $13.13 | $30.48 | $54.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.64 / $22.72 / $28.40
| Professional | | $12.64 | $22.72 | $28.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.06 / $16.36 / $100.00
| Facility | | $14.06 | $16.36 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.88 / $11.01 / $15.31
| Professional | | $7.88 | $11.01 | $15.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.88 / $11.01 / $15.00
| Professional | | $7.88 | $11.01 | $15.00 |