- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.57 / $290.57 / $290.57
| Professional | | $290.57 | $290.57 | $290.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64,999.99 / $64,999.99 / $86,999.99
| Facility | | $64,999.99 | $64,999.99 | $86,999.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.53 / $701.53 / $701.53
| Facility | | $701.53 | $701.53 | $701.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.53 / $701.53 / $701.53
| Professional | | $701.53 | $701.53 | $701.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.53 / $701.53 / $701.53
| Facility | | $701.53 | $701.53 | $701.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.57 / $330.89 / $701.53
| Professional | | $233.57 | $330.89 | $701.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.00 / $340.94 / $415.55
| Professional | | $221.00 | $340.94 | $415.55 |