- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.60 / $234.60 / $234.60
| Facility | | $234.60 | $234.60 | $234.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.60 / $294.05 / $294.05
| Professional | | $234.60 | $294.05 | $294.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.58 / $294.77 / $346.80
| Professional | | $292.58 | $294.77 | $346.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.13 / $364.13 / $455.16
| Professional | | $364.13 | $364.13 | $455.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.81 / $234.60 / $703.80
| Facility | | $224.81 | $234.60 | $703.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.61 / $424.91 / $506.34
| Professional | | $246.61 | $424.91 | $506.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.60 / $430.37 / $534.89
| Professional | | $234.60 | $430.37 | $534.89 |