- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.10 / $322.75 / $369.77
| Facility | | $300.10 | $322.75 | $369.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.10 / $369.77 / $523.16
| Professional | | $300.10 | $369.77 | $523.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.25 / $527.25 / $527.25
| Facility | | $527.25 | $527.25 | $527.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.89 / $384.89 / $527.25
| Professional | | $384.89 | $384.89 | $527.25 |
- 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
- $316.94 / $528.24 / $702.90
| Professional | | $316.94 | $528.24 | $702.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.32 / $562.32 / $562.32
| Professional | | $562.32 | $562.32 | $562.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.85 / $350.67 / $528.35
| Professional | | $301.85 | $350.67 | $528.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.28 / $426.28 / $702.90
| Professional | | $426.28 | $426.28 | $702.90 |