- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.84 / $169.58 / $186.53
| Professional | | $155.84 | $169.58 | $186.53 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $254.00 / $254.00 / $254.00
| Professional | | $254.00 | $254.00 | $254.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.79 / $287.79 / $287.79
| Facility | | $287.79 | $287.79 | $287.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.10 / $258.18 / $372.40
| Professional | | $172.10 | $258.18 | $372.40 |