- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.18 / $14.61 / $177.66
| Facility | | $11.18 | $14.61 | $177.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $14.40 / $24.10
| Professional | | $10.23 | $14.40 | $24.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.02 / $27.40 / $32.22
| Professional | | $24.02 | $27.40 | $32.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.43 / $13.03 / $16.23
| Professional | | $10.43 | $13.03 | $16.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.28 / $21.85 / $100.00
| Facility | | $14.28 | $21.85 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.58 / $14.66 / $29.01
| Professional | | $12.58 | $14.66 | $29.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.09 / $13.59 / $23.99
| Professional | | $11.09 | $13.59 | $23.99 |