- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.74 / $13.74 / $35.33
| Facility | | $13.74 | $13.74 | $35.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.07 / $17.66 / $19.63
| Professional | | $17.07 | $17.66 | $19.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.55 / $39.54 / $44.17
| Professional | | $29.55 | $39.54 | $44.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.72 / $22.94 / $28.85
| Professional | | $22.72 | $22.94 | $28.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.74 / $23.36 / $100.00
| Facility | | $13.74 | $23.36 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.73 / $23.56 / $33.65
| Professional | | $9.73 | $23.56 | $33.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.24 / $20.02 / $33.65
| Professional | | $8.24 | $20.02 | $33.65 |