- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.56 / $114.53 / $164.48
| Professional | | $101.56 | $114.53 | $164.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.98 / $123.98 / $195.37
| Facility | | $123.98 | $123.98 | $195.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.38 / $123.98 / $127.70
| Professional | | $105.38 | $123.98 | $127.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99,999.99 / $99,999.99 / $99,999.99
| Facility | | $99,999.99 | $99,999.99 | $99,999.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.66 / $206.96 / $301.32
| Professional | | $150.66 | $206.96 | $301.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.35 / $188.03 / $208.93
| Professional | | $125.35 | $188.03 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.77 / $113.18 / $188.53
| Professional | | $91.77 | $113.18 | $188.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Professional | | $208.93 | $208.93 | $208.93 |