- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.33 / $297.33 / $330.04
| Facility | | $297.33 | $297.33 | $330.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.33 / $297.33 / $330.04
| Professional | | $297.33 | $297.33 | $330.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.50 / $214.50 / $214.50
| Facility | | $214.50 | $214.50 | $214.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.48 / $326.48 / $326.48
| Facility | | $326.48 | $326.48 | $326.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.48 / $326.48 / $326.48
| Professional | | $326.48 | $326.48 | $326.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $17.00 / $20.00
| Professional | | $17.00 | $17.00 | $20.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.25 / $333.58 / $349.80
| Professional | | $300.25 | $333.58 | $349.80 |