- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.96 / $140.84 / $161.35
| Facility | | $130.96 | $140.84 | $161.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.96 / $157.02 / $228.29
| Professional | | $130.96 | $157.02 | $228.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.29 / $170.29 / $170.29
| Facility | | $170.29 | $170.29 | $170.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.75 / $144.75 / $170.29
| Professional | | $144.75 | $144.75 | $170.29 |
- 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
- $138.30 / $221.41 / $306.73
| Professional | | $138.30 | $221.41 | $306.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.38 / $245.38 / $245.38
| Professional | | $245.38 | $245.38 | $245.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.71 / $153.02 / $204.85
| Professional | | $131.71 | $153.02 | $204.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.70 / $164.70 / $306.73
| Professional | | $164.70 | $164.70 | $306.73 |