- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.29 / $622.28 / $842.85
| Professional | | $532.29 | $622.28 | $842.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $542.66 / $542.66 / $542.66
| Facility | | $542.66 | $542.66 | $542.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.14 / $461.26 / $745.07
| Professional | | $396.14 | $461.26 | $745.07 |
- 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
- $638.75 / $1,064.58 / $1,384.79
| Professional | | $638.75 | $1,064.58 | $1,384.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.30 / $731.07 / $913.84
| Professional | | $548.30 | $731.07 | $913.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.45 / $597.35 / $904.89
| Professional | | $452.45 | $597.35 | $904.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.89 / $904.89 / $904.89
| Professional | | $904.89 | $904.89 | $904.89 |