- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.84 / $212.60 / $253.67
| Facility | | $191.84 | $212.60 | $253.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.28 / $210.07 / $315.55
| Professional | | $124.28 | $210.07 | $315.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $312.30 / $312.30 / $312.30
| Facility | | $312.30 | $312.30 | $312.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.98 / $227.98 / $312.30
| Professional | | $227.98 | $227.98 | $312.30 |
- 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
- $176.50 / $294.16 / $419.82
| Professional | | $176.50 | $294.16 | $419.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.08 / $213.85 / $235.23
| Professional | | $171.08 | $213.85 | $235.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.19 / $230.99 / $329.43
| Professional | | $181.19 | $230.99 | $329.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.85 / $213.85 / $254.13
| Professional | | $213.85 | $213.85 | $254.13 |