- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.60 / $47.00 / $225.82
| Professional | | $43.60 | $47.00 | $225.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64,999.99 / $81,499.99 / $94,999.99
| Facility | | $64,999.99 | $81,499.99 | $94,999.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.50 / $193.50 / $193.50
| Professional | | $193.50 | $193.50 | $193.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.34 / $68.34 / $68.34
| Facility | | $68.34 | $68.34 | $68.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.49 / $68.34 / $68.34
| Professional | | $60.49 | $68.34 | $68.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.34 / $91.00 / $94.24
| Facility | | $68.34 | $91.00 | $94.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.73 / $60.49 / $90.30
| Professional | | $41.73 | $60.49 | $90.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.55 / $76.79 / $121.17
| Professional | | $66.55 | $76.79 | $121.17 |