- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.96 / $68.81 / $108.33
| Professional | | $50.96 | $68.81 | $108.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.31 / $33.10 / $51.70
| Professional | | $12.31 | $33.10 | $51.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.16 / $131.01 / $141.15
| Professional | | $101.16 | $131.01 | $141.15 |
- 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
- $27.00 / $38.99 / $10,000.00
| Professional | | $27.00 | $38.99 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.05 / $100.54 / $153.63
| Professional | | $22.05 | $100.54 | $153.63 |