- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $11.53 / $15.38
| Professional | | $9.77 | $11.53 | $15.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.23 / $15.57 / $22.94
| Professional | | $13.23 | $15.57 | $22.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $20.07 / $88.68
| Professional | | $8.91 | $20.07 | $88.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.00 / $1,183.00 / $3,774.00
| Facility | | $437.00 | $1,183.00 | $3,774.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $17.32 / $26.65
| Professional | | $10.74 | $17.32 | $26.65 |