- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.75 / $96.45 / $441.28
| Professional | | $53.75 | $96.45 | $441.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64,999.99 / $81,499.99 / $94,999.99
| Facility | | $64,999.99 | $81,499.99 | $94,999.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.55 / $82.55 / $82.55
| Facility | | $82.55 | $82.55 | $82.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.98 / $82.55 / $188.74
| Professional | | $72.98 | $82.55 | $188.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.55 / $189.15 / $196.71
| Facility | | $82.55 | $189.15 | $196.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.03 / $88.68 / $177.10
| Professional | | $55.03 | $88.68 | $177.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.72 / $141.60 / $235.87
| Professional | | $122.72 | $141.60 | $235.87 |