- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.33 / $109.65 / $153.58
| Professional | | $105.33 | $109.65 | $153.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.92 / $61.92 / $61.92
| Professional | | $61.92 | $61.92 | $61.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.33 / $153.58 / $184.30
| Facility | | $105.33 | $153.58 | $184.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.00 / $153.28 / $161.35
| Professional | | $98.00 | $153.28 | $161.35 |
- 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
- $92.09 / $153.58 / $184.30
| Facility | | $92.09 | $153.58 | $184.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.92 / $151.18 / $10,000.00
| Professional | | $61.92 | $151.18 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.36 / $80.50 / $286.39
| Professional | | $64.36 | $80.50 | $286.39 |