- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.83 / $299.83 / $365.38
| Professional | | $299.83 | $299.83 | $365.38 |
- 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
- $109.45 / $109.45 / $136.81
| Professional | | $109.45 | $109.45 | $136.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.83 / $299.83 / $383.80
| Facility | | $299.83 | $299.83 | $383.80 |
- 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 |