- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.59 / $61.80 / $275.00
| Facility | | $49.59 | $61.80 | $275.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.82 / $27.22 / $54.10
| Professional | | $18.82 | $27.22 | $54.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.29 / $21.03 / $28.04
| Professional | | $18.29 | $21.03 | $28.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.30 / $24.60 / $35.53
| Professional | | $18.30 | $24.60 | $35.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.00 / $28.32 / $50.00
| Professional | | $19.00 | $28.32 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.17 / $29.20 / $38.44
| Professional | | $0.17 | $29.20 | $38.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.23 / $102.23 / $102.23
| Facility | | $102.23 | $102.23 | $102.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.16 / $24.33 / $28.04
| Professional | | $24.16 | $24.33 | $28.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.74 / $40.00 / $47.93
| Professional | | $25.74 | $40.00 | $47.93 |