- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.20 / $275.20 / $413.30
| Professional | | $246.20 | $275.20 | $413.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.41 / $77,999.99 / $94,999.99
| Facility | | $526.41 | $77,999.99 | $94,999.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.10 / $298.10 / $298.10
| Facility | | $298.10 | $298.10 | $298.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.49 / $269.49 / $298.10
| Professional | | $269.49 | $269.49 | $298.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.10 / $298.10 / $298.10
| Facility | | $298.10 | $298.10 | $298.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.49 / $283.31 / $369.54
| Professional | | $269.49 | $283.31 | $369.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.89 / $271.89 / $288.74
| Professional | | $271.89 | $271.89 | $288.74 |