- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.99 / $240.00 / $307.42
| Professional | | $203.99 | $240.00 | $307.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.24 / $53.77 / $201.36
| Facility | | $48.24 | $53.77 | $201.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.00 / $254.00 / $317.49
| Professional | | $254.00 | $254.00 | $317.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.42 / $307.42 / $393.50
| Facility | | $307.42 | $307.42 | $393.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $78.00
| Professional | | $55.00 | $55.00 | $78.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.68 / $137.74 / $214.63
| Facility | | $97.68 | $137.74 | $214.63 |