- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.63 / $32.04 / $36.09
| Professional | | $26.63 | $32.04 | $36.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.00 / $90.00 / $90.00
| Facility | | $90.00 | $90.00 | $90.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.32 / $52.23 / $112.44
| Professional | | $48.32 | $52.23 | $112.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.95 / $42.23 / $57.45
| Professional | | $38.95 | $42.23 | $57.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.80 / $54.70 / $74.30
| Professional | | $47.80 | $54.70 | $74.30 |