- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.48 / $115.94 / $579.22
| Professional | | $95.48 | $115.94 | $579.22 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $138.55 / $163.00 / $193.75
| Facility | | $138.55 | $163.00 | $193.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.95 / $146.69 / $234.79
| Professional | | $105.95 | $146.69 | $234.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.48 / $100.89 / $163.00
| Facility | | $66.48 | $100.89 | $163.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.31 / $146.30 / $193.67
| Professional | | $99.31 | $146.30 | $193.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.69 / $177.84 / $284.89
| Professional | | $141.69 | $177.84 | $284.89 |