- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.18 / $294.85 / $785.44
| Professional | | $147.18 | $294.85 | $785.44 |
- 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
- $243.45 / $243.45 / $540.52
| Professional | | $243.45 | $243.45 | $540.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.45 / $243.45 / $243.45
| Facility | | $243.45 | $243.45 | $243.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.19 / $366.16 / $554.05
| Professional | | $172.19 | $366.16 | $554.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.10 / $359.36 / $634.05
| Facility | | $157.10 | $359.36 | $634.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.94 / $410.40 / $785.18
| Professional | | $214.94 | $410.40 | $785.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.75 / $554.46 / $655.19
| Professional | | $473.75 | $554.46 | $655.19 |