- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.06 / $43.89 / $53.29
| Professional | | $42.06 | $43.89 | $53.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.57 / $22.57 / $22.57
| Professional | | $22.57 | $22.57 | $22.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.88 / $42.06 / $50.47
| Facility | | $37.88 | $42.06 | $50.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.98 / $51.07 / $52.00
| Professional | | $41.98 | $51.07 | $52.00 |
- 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
- $33.56 / $42.06 / $50.47
| Facility | | $33.56 | $42.06 | $50.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.57 / $51.78 / $10,000.00
| Professional | | $22.57 | $51.78 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.68 / $23.46 / $104.38
| Professional | | $21.68 | $23.46 | $104.38 |