- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.86 / $586.94 / $738.27
| Professional | | $142.86 | $586.94 | $738.27 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $222.94 / $222.94 / $222.94
| Professional | | $222.94 | $222.94 | $222.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.94 / $222.94 / $222.94
| Facility | | $222.94 | $222.94 | $222.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.48 / $222.94 / $789.67
| Professional | | $193.48 | $222.94 | $789.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.94 / $222.94 / $222.94
| Facility | | $222.94 | $222.94 | $222.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.26 / $415.31 / $833.79
| Professional | | $148.26 | $415.31 | $833.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $814.84 / $971.54 / $2,374.69
| Professional | | $814.84 | $971.54 | $2,374.69 |