- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.98 / $285.89 / $1,126.28
| Professional | | $213.98 | $285.89 | $1,126.28 |
- 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
- $335.46 / $335.46 / $335.46
| Facility | | $335.46 | $335.46 | $335.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.52 / $335.46 / $369.57
| Professional | | $181.52 | $335.46 | $369.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $228.20 / $335.46
| Facility | | $165.96 | $228.20 | $335.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.75 / $335.46 / $446.60
| Professional | | $205.75 | $335.46 | $446.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.82 / $363.66 / $421.08
| Professional | | $321.82 | $363.66 | $421.08 |