- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.20 / $4,266.10 / $30,678.78
| Facility | | $673.20 | $4,266.10 | $30,678.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.76 / $2,088.90 / $8,977.95
| Professional | | $32.76 | $2,088.90 | $8,977.95 |
- 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
- $269.89 / $269.89 / $269.89
| Facility | | $269.89 | $269.89 | $269.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.89 / $269.89 / $277.99
| Professional | | $269.89 | $269.89 | $277.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.89 / $269.89 / $269.89
| Facility | | $269.89 | $269.89 | $269.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.89 / $269.89 / $277.99
| Professional | | $269.89 | $269.89 | $277.99 |