- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.19 / $577.58 / $1,286.76
| Professional | | $535.19 | $577.58 | $1,286.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,000.00 / $81,499.99 / $94,999.99
| Facility | | $47,000.00 | $81,499.99 | $94,999.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.79 / $598.79 / $598.79
| Facility | | $598.79 | $598.79 | $598.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $598.79
| Professional | | $529.89 | $529.89 | $598.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.79 / $598.79 / $598.79
| Facility | | $598.79 | $598.79 | $598.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $574.89 / $749.85
| Professional | | $529.89 | $574.89 | $749.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $529.89
| Professional | | $529.89 | $529.89 | $529.89 |