- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.89 / $77.83 / $107.95
| Facility | | $68.89 | $77.83 | $107.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.07 / $10.54 / $14.46
| Professional | | $9.07 | $10.54 | $14.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $24.36 / $27.20
| Professional | | $18.20 | $24.36 | $27.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.63 / $13.77 / $17.30
| Professional | | $13.63 | $13.77 | $17.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.09 / $35.69 / $100.00
| Facility | | $12.09 | $35.69 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.05 / $14.51 / $41.40
| Professional | | $6.05 | $14.51 | $41.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.08 / $12.33 / $20.73
| Professional | | $5.08 | $12.33 | $20.73 |