- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.06 / $10.82 / $19.32
| Professional | | $10.06 | $10.82 | $19.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.14 / $483.14 / $483.14
| Professional | | $483.14 | $483.14 | $483.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.83 / $18.54 / $493.00
| Professional | | $12.83 | $18.54 | $493.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.06 / $12.19 / $359.80
| Facility | | $10.06 | $12.19 | $359.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.27 / $14.91 / $1,889.17
| Professional | | $11.27 | $14.91 | $1,889.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $13.62 / $205.80
| Professional | | $10.68 | $13.62 | $205.80 |