- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.81 / $20.00 / $50.43
| Facility | | $10.81 | $20.00 | $50.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.09 / $11.38 / $13.61
| Professional | | $10.09 | $11.38 | $13.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.36 / $16.01 / $19.66
| Professional | | $9.36 | $16.01 | $19.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.56 / $31.39 / $55.31
| Facility | | $9.56 | $31.39 | $55.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.56 / $11.08 / $21.17
| Professional | | $6.56 | $11.08 | $21.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.07 / $70.00 / $70.00
| Facility | | $25.07 | $70.00 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.05 / $8.65 / $20.14
| Professional | | $6.05 | $8.65 | $20.14 |