- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.07 / $39.52 / $49.36
| Professional | | $35.07 | $39.52 | $49.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.46 / $717.61 / $1,476.23
| Facility | | $157.46 | $717.61 | $1,476.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119,998.80 / $119,998.80 / $119,998.80
| Professional | | $119,998.80 | $119,998.80 | $119,998.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.82 / $52.82 / $52.82
| Facility | | $52.82 | $52.82 | $52.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.36 / $207.36 / $207.36
| Professional | | $207.36 | $207.36 | $207.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.50 / $39.95 / $76.84
| Professional | | $32.50 | $39.95 | $76.84 |