- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.39 / $111.78 / $114.62
| Professional | | $106.39 | $111.78 | $114.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.08 / $60.08 / $60.08
| Professional | | $60.08 | $60.08 | $60.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.83 / $111.78 / $134.13
| Facility | | $100.83 | $111.78 | $134.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.57 / $111.57 / $133.35
| Professional | | $111.57 | $111.57 | $133.35 |
- 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
- $100.83 / $111.78 / $134.13
| Facility | | $100.83 | $111.78 | $134.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.08 / $137.63 / $10,000.00
| Professional | | $60.08 | $137.63 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.75 / $58.58 / $277.89
| Professional | | $56.75 | $58.58 | $277.89 |