- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.32 / $131.32 / $142.36
| Facility | | $131.32 | $131.32 | $142.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.45 / $11.88 / $18.51
| Professional | | $10.45 | $11.88 | $18.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.83 / $14.63 / $23.46
| Professional | | $12.83 | $14.63 | $23.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.40 / $10.96 / $20.50
| Facility | | $8.40 | $10.96 | $20.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.40 / $16.82 / $25.69
| Professional | | $8.40 | $16.82 | $25.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.84 / $19.80 / $23.76
| Professional | | $15.84 | $19.80 | $23.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.65 / $9.50 / $10.32
| Professional | | $6.65 | $9.50 | $10.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.18 / $7.92 / $15.55
| Professional | | $6.18 | $7.92 | $15.55 |