- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $15.85 / $32.36
| Facility | | $12.02 | $15.85 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $15.85 / $53.70
| Professional | | $12.02 | $15.85 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $33.88 / $39.81
| Professional | | $25.70 | $33.88 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $20.42 / $26.30
| Professional | | $20.42 | $20.42 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $21.38 / $100.00
| Facility | | $12.30 | $21.38 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.17 / $8.91 / $30.20
| Professional | | $6.17 | $8.91 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.17 / $14.13 / $25.70
| Professional | | $6.17 | $14.13 | $25.70 |