- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.22 / $143.77 / $404.53
| Professional | | $133.22 | $143.77 | $404.53 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $152.57 / $152.57 / $152.57
| Facility | | $152.57 | $152.57 | $152.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.90 / $152.57 / $152.57
| Professional | | $131.90 | $152.57 | $152.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.90 / $152.57 / $180.45
| Facility | | $131.90 | $152.57 | $180.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.09 / $143.09 / $186.65
| Professional | | $143.09 | $143.09 | $186.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.90 / $131.90 / $131.90
| Professional | | $131.90 | $131.90 | $131.90 |