- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.43 / $137.69 / $496.00
| Professional | | $50.43 | $137.69 | $496.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.52 / $275.52 / $1,269.59
| Professional | | $275.52 | $275.52 | $1,269.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.57 / $228.57 / $228.57
| Facility | | $228.57 | $228.57 | $228.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.89 / $99.89 / $136.97
| Professional | | $99.89 | $99.89 | $136.97 |
- 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
- $99,999.99 / $99,999.99 / $99,999.99
| Professional | | $99,999.99 | $99,999.99 | $99,999.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Professional | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,250.00 / $3,250.00 / $3,250.00
| Professional | | $3,250.00 | $3,250.00 | $3,250.00 |