- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.07 / $12.44 / $53.67
| Professional | | $9.07 | $12.44 | $53.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.34 / $343.34 / $733.16
| Professional | | $343.34 | $343.34 | $733.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.57 / $18.48 / $282.73
| Professional | | $10.57 | $18.48 | $282.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.44 / $31.65 / $406.78
| Facility | | $12.44 | $31.65 | $406.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.89 / $12.86 / $137.49
| Professional | | $9.89 | $12.86 | $137.49 |