- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.26 / $108.53 / $143.82
| Professional | | $90.26 | $108.53 | $143.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.15 / $83.15 / $83.15
| Facility | | $83.15 | $83.15 | $83.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.70 / $70.68 / $139.66
| Professional | | $60.70 | $70.68 | $139.66 |
- 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
- $108.31 / $180.52 / $234.81
| Professional | | $108.31 | $180.52 | $234.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.97 / $123.96 / $154.96
| Professional | | $92.97 | $123.96 | $154.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.72 / $105.33 / $153.44
| Professional | | $76.72 | $105.33 | $153.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.44 / $153.44 / $153.44
| Professional | | $153.44 | $153.44 | $153.44 |