- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.69 / $1,579.08 / $1,579.08
| Professional | | $259.69 | $1,579.08 | $1,579.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.16 / $77,999.99 / $94,999.99
| Facility | | $675.16 | $77,999.99 | $94,999.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.93 / $338.70 / $653.33
| Facility | | $171.93 | $338.70 | $653.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.12 / $361.22 / $481.90
| Professional | | $123.12 | $361.22 | $481.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.93 / $338.70 / $653.33
| Facility | | $171.93 | $338.70 | $653.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.95 / $297.44 / $481.90
| Professional | | $209.95 | $297.44 | $481.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.44 / $139.44 / $232.42
| Professional | | $139.44 | $139.44 | $232.42 |