- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.40 / $57.32 / $93.03
| Professional | | $43.40 | $57.32 | $93.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $40.03 / $51.48
| Professional | | $27.54 | $40.03 | $51.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.11 / $111.60 / $120.15
| Professional | | $86.11 | $111.60 | $120.15 |
- 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
- $27.54 / $76.00 / $10,000.00
| Professional | | $27.54 | $76.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.06 / $61.13 / $130.19
| Professional | | $34.06 | $61.13 | $130.19 |