- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.00 / $198.58 / $211.33
| Professional | | $184.00 | $198.58 | $211.33 |
- 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
- $205.52 / $205.52 / $205.52
| Facility | | $205.52 | $205.52 | $205.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.18 / $205.52 / $205.52
| Professional | | $182.18 | $205.52 | $205.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.18 / $205.52 / $225.05
| Facility | | $182.18 | $205.52 | $225.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.65 / $197.65 / $257.80
| Professional | | $197.65 | $197.65 | $257.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.18 / $182.18 / $182.18
| Professional | | $182.18 | $182.18 | $182.18 |