- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.71 / $63.35 / $65.54
| Professional | | $62.71 | $63.35 | $65.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.19 / $32.19 / $32.19
| Professional | | $32.19 | $32.19 | $32.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.93 / $55.36 / $77.34
| Facility | | $43.93 | $55.36 | $77.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.19 / $67.25 / $10,000.00
| Professional | | $32.19 | $67.25 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.24 / $33.46 / $48.00
| Professional | | $30.24 | $33.46 | $48.00 |