- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.80 / $19.32 / $31.84
| Professional | | $15.80 | $19.32 | $31.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.57 / $14.59 / $274.20
| Professional | | $10.57 | $14.59 | $274.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.40 / $19.32 / $522.46
| Facility | | $12.40 | $19.32 | $522.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.24 / $40.77 / $43.59
| Professional | | $31.24 | $40.77 | $43.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Professional | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.36 / $22.22 / $522.46
| Facility | | $11.36 | $22.22 | $522.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.57 / $351.00 / $10,000.00
| Professional | | $10.57 | $351.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.25 / $29.52 / $163.80
| Professional | | $12.25 | $29.52 | $163.80 |