- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.40 / $14.11 / $20.53
| Facility | | $10.40 | $14.11 | $20.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.78 / $10.40 / $10.40
| Professional | | $9.78 | $10.40 | $10.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.07 / $13.62 / $100.00
| Facility | | $9.07 | $13.62 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.73 / $10.19 / $673.81
| Professional | | $3.73 | $10.19 | $673.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.47 / $14.28 / $27.75
| Facility | | $12.47 | $14.28 | $27.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.40 / $10.40 / $10.40
| Facility | | $10.40 | $10.40 | $10.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $10.40 / $10.40
| Professional | | $10.40 | $10.40 | $10.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $10.40 / $12.04
| Professional | | $10.40 | $10.40 | $12.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $100.00 / $100.00
| Facility | | $75.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.19 / $10.81 / $673.81
| Professional | | $10.19 | $10.81 | $673.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.19 / $10.40 / $12.64
| Professional | | $10.19 | $10.40 | $12.64 |