- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.91 / $191.91 / $211.11
| Professional | | $191.91 | $191.91 | $211.11 |
- 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
- $184.39 / $184.39 / $184.39
| Facility | | $184.39 | $184.39 | $184.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.39 / $188.55 / $188.55
| Professional | | $184.39 | $188.55 | $188.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.39 / $184.39 / $184.39
| Facility | | $184.39 | $184.39 | $184.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.55 / $208.22 / $271.58
| Professional | | $188.55 | $208.22 | $271.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.24 / $190.24 / $202.02
| Professional | | $190.24 | $190.24 | $202.02 |