- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.83 / $479.58 / $595.20
| Professional | | $474.83 | $479.58 | $595.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,268.66 / $77,999.99 / $94,999.99
| Facility | | $1,268.66 | $77,999.99 | $94,999.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.48 / $538.37 / $835.19
| Facility | | $480.48 | $538.37 | $835.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.84 / $474.84 / $538.37
| Professional | | $474.84 | $474.84 | $538.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.48 / $538.37 / $835.19
| Facility | | $480.48 | $538.37 | $835.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.84 / $515.15 / $671.94
| Professional | | $474.84 | $515.15 | $671.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.84 / $474.84 / $474.84
| Professional | | $474.84 | $474.84 | $474.84 |