- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.26 / $93.91 / $125.22
| Professional | | $78.26 | $93.91 | $125.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.45 / $98.45 / $98.45
| Facility | | $98.45 | $98.45 | $98.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.68 / $98.45 / $98.45
| Professional | | $83.68 | $98.45 | $98.45 |
- 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
- $93.91 / $160.28 / $99,999.99
| Professional | | $93.91 | $160.28 | $99,999.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.32 / $59.87 / $120.20
| Facility | | $7.32 | $59.87 | $120.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.61 / $93.91 / $126.39
| Professional | | $62.61 | $93.91 | $126.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.00 / $560.00 / $560.00
| Professional | | $560.00 | $560.00 | $560.00 |