- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.00 / $486.21 / $650.38
| Professional | | $401.00 | $486.21 | $650.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.39 / $369.39 / $369.39
| Facility | | $369.39 | $369.39 | $369.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.64 / $313.98 / $604.79
| Professional | | $269.64 | $313.98 | $604.79 |
- 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
- $481.19 / $801.99 / $1,043.22
| Professional | | $481.19 | $801.99 | $1,043.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.05 / $550.74 / $688.43
| Professional | | $413.05 | $550.74 | $688.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.93 / $461.89 / $641.59
| Professional | | $374.93 | $461.89 | $641.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.69 / $681.69 / $681.69
| Professional | | $681.69 | $681.69 | $681.69 |