- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.15 / $171.30 / $328.80
| Professional | | $66.15 | $171.30 | $328.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.63 / $79.50 / $126.31
| Professional | | $50.63 | $79.50 | $126.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.65 / $181.00 / $367.00
| Professional | | $175.65 | $181.00 | $367.00 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $50.63 / $118.98 / $10,000.00
| Professional | | $50.63 | $118.98 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.35 / $160.33 / $473.82
| Professional | | $84.35 | $160.33 | $473.82 |