- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.88 / $427.88 / $427.88
| Facility | | $427.88 | $427.88 | $427.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.80 / $237.80 / $427.88
| Professional | | $237.80 | $237.80 | $427.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,799.99 / $68,899.99 / $81,099.99
| Facility | | $56,799.99 | $68,899.99 | $81,099.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.36 / $399.36 / $399.36
| Facility | | $399.36 | $399.36 | $399.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.36 / $399.36 / $399.36
| Professional | | $399.36 | $399.36 | $399.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.51 / $399.36 / $399.36
| Facility | | $265.51 | $399.36 | $399.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.36 / $399.36 / $399.36
| Professional | | $399.36 | $399.36 | $399.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.14 / $427.88 / $427.88
| Professional | | $251.14 | $427.88 | $427.88 |