- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.93 / $131.75 / $195.30
| Professional | | $91.93 | $131.75 | $195.30 |
- 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
- $155.63 / $155.63 / $185.00
| Facility | | $155.63 | $155.63 | $185.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.92 / $110.95 / $202.98
| Professional | | $79.92 | $110.95 | $202.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.12 / $141.47 / $204.93
| Facility | | $101.12 | $141.47 | $204.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.98 / $182.37 / $269.60
| Professional | | $105.98 | $182.37 | $269.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.78 / $190.81 / $210.55
| Professional | | $167.78 | $190.81 | $210.55 |