- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.53 / $119.29 / $126.95
| Professional | | $110.53 | $119.29 | $126.95 |
- 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
- $235.71 / $235.71 / $235.71
| Facility | | $235.71 | $235.71 | $235.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.44 / $235.71 / $235.71
| Professional | | $109.44 | $235.71 | $235.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.44 / $235.71 / $314.81
| Facility | | $109.44 | $235.71 | $314.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.73 / $118.73 / $302.23
| Professional | | $118.73 | $118.73 | $302.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.44 / $109.44 / $109.44
| Professional | | $109.44 | $109.44 | $109.44 |