- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.29 / $161.81 / $272.04
| Professional | | $64.29 | $161.81 | $272.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.85 / $77,999.99 / $94,999.99
| Facility | | $480.85 | $77,999.99 | $94,999.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.58 / $103.58 / $372.50
| Facility | | $103.58 | $103.58 | $372.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.03 / $154.05 / $317.13
| Professional | | $72.03 | $154.05 | $317.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.39 / $197.27 / $309.93
| Facility | | $68.39 | $197.27 | $309.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.83 / $195.51 / $435.00
| Professional | | $89.83 | $195.51 | $435.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.27 / $311.85 / $359.37
| Professional | | $257.27 | $311.85 | $359.37 |