- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.16 / $21.63 / $56.59
| Facility | | $12.16 | $21.63 | $56.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.60 / $13.58 / $14.81
| Professional | | $9.60 | $13.58 | $14.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.80 / $7.80 / $36.72
| Professional | | $7.80 | $7.80 | $36.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.57 / $17.32 / $20.45
| Professional | | $8.57 | $17.32 | $20.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.33 / $33.59 / $59.82
| Facility | | $10.33 | $33.59 | $59.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.16 / $10.34 / $22.00
| Professional | | $7.16 | $10.34 | $22.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.29 / $74.31 / $74.31
| Facility | | $36.29 | $74.31 | $74.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.55 / $10.30 / $23.39
| Professional | | $6.55 | $10.30 | $23.39 |