- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.03 / $199.03 / $229.65
| Professional | | $199.03 | $199.03 | $229.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.97 / $329.97 / $329.97
| Professional | | $329.97 | $329.97 | $329.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.26 / $233.26 / $299.77
| Facility | | $233.26 | $233.26 | $299.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.28 / $170.28 / $232.54
| Professional | | $170.28 | $170.28 | $232.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.26 / $233.26 / $299.77
| Facility | | $233.26 | $233.26 | $299.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.28 / $170.28 / $232.54
| Professional | | $170.28 | $170.28 | $232.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.65 / $241.60 / $471.51
| Professional | | $135.65 | $241.60 | $471.51 |