- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.94 / $524.64 / $720.56
| Professional | | $411.94 | $524.64 | $720.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,355.54 / $2,355.54 / $2,355.54
| Facility | | $2,355.54 | $2,355.54 | $2,355.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,504.69 / $2,355.54 / $2,355.54
| Professional | | $1,504.69 | $2,355.54 | $2,355.54 |
- 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
- $773.90 / $822.00 / $99,999.99
| Professional | | $773.90 | $822.00 | $99,999.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.88 / $99.86 / $998.60
| Professional | | $79.88 | $99.86 | $998.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.58 / $418.69 / $668.59
| Professional | | $350.58 | $418.69 | $668.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.30 / $773.30 / $773.30
| Professional | | $773.30 | $773.30 | $773.30 |