- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.45 / $613.73 / $823.27
| Professional | | $507.45 | $613.73 | $823.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.97 / $394.97 / $394.97
| Facility | | $394.97 | $394.97 | $394.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.33 / $335.72 / $777.60
| Professional | | $288.33 | $335.72 | $777.60 |
- 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
- $608.94 / $1,014.90 / $1,320.16
| Professional | | $608.94 | $1,014.90 | $1,320.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.71 / $696.95 / $871.19
| Professional | | $522.71 | $696.95 | $871.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.22 / $583.45 / $849.39
| Professional | | $432.22 | $583.45 | $849.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $862.67 / $862.67 / $862.67
| Professional | | $862.67 | $862.67 | $862.67 |