- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.98 / $254.98 / $254.98
| Professional | | $254.98 | $254.98 | $254.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.22 / $324.22 / $324.22
| Facility | | $324.22 | $324.22 | $324.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.73 / $283.73 / $354.66
| Professional | | $283.73 | $283.73 | $354.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.22 / $324.22 / $324.22
| Facility | | $324.22 | $324.22 | $324.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.66 / $283.73 / $354.66
| Professional | | $133.66 | $283.73 | $354.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.25 / $123.38 / $287.88
| Professional | | $110.25 | $123.38 | $287.88 |