- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.66 / $197.12 / $350.72
| Professional | | $148.66 | $197.12 | $350.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68,099.99 / $68,099.99 / $81,499.99
| Facility | | $68,099.99 | $68,099.99 | $81,499.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.00 / $801.00 / $801.00
| Professional | | $801.00 | $801.00 | $801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.56 / $281.83 / $330.20
| Facility | | $239.56 | $281.83 | $330.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.86 / $281.83 / $372.59
| Professional | | $185.86 | $281.83 | $372.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.90 / $224.03 / $400.37
| Facility | | $172.90 | $224.03 | $400.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.39 / $344.01 / $519.65
| Professional | | $206.39 | $344.01 | $519.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.39 / $364.82 / $415.14
| Professional | | $299.39 | $364.82 | $415.14 |