- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.34 / $1,064.23 / $1,064.23
| Professional | | $190.34 | $1,064.23 | $1,064.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $576.63 / $68,999.99 / $94,999.99
| Facility | | $576.63 | $68,999.99 | $94,999.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.99 / $281.37 / $943.41
| Facility | | $239.99 | $281.37 | $943.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.99 / $239.99 / $239.99
| Professional | | $239.99 | $239.99 | $239.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.99 / $281.37 / $943.41
| Facility | | $239.99 | $281.37 | $943.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.96 / $148.96 / $239.99
| Professional | | $148.96 | $148.96 | $239.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.51 / $69.51 / $165.51
| Professional | | $69.51 | $69.51 | $165.51 |