- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.94 / $62.57 / $68.41
| Professional | | $61.94 | $62.57 | $68.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.32 / $33.32 / $33.32
| Professional | | $33.32 | $33.32 | $33.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.61 / $56.22 / $78.55
| Facility | | $44.61 | $56.22 | $78.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.32 / $66.42 / $10,000.00
| Professional | | $33.32 | $66.42 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.30 / $34.63 / $49.68
| Professional | | $31.30 | $34.63 | $49.68 |