- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.94 / $177.58 / $238.76
| Professional | | $141.94 | $177.58 | $238.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.43 / $244.43 / $244.43
| Facility | | $244.43 | $244.43 | $244.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.43 / $207.77 / $244.43
| Professional | | $178.43 | $207.77 | $244.43 |
- 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
- $170.34 / $283.89 / $369.30
| Professional | | $170.34 | $283.89 | $369.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.22 / $194.96 / $243.70
| Professional | | $146.22 | $194.96 | $243.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.66 / $169.20 / $237.60
| Professional | | $120.66 | $169.20 | $237.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.32 / $241.32 / $241.32
| Professional | | $241.32 | $241.32 | $241.32 |