- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.94 / $343.30 / $467.91
| Facility | | $299.94 | $343.30 | $467.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.94 / $343.30 / $343.30
| Professional | | $299.94 | $343.30 | $343.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.41 / $253.41 / $253.41
| Facility | | $253.41 | $253.41 | $253.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.74 / $253.41 / $281.87
| Professional | | $240.74 | $253.41 | $281.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.38 / $361.38 / $451.73
| Professional | | $361.38 | $361.38 | $451.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.97 / $343.30 / $551.14
| Facility | | $308.97 | $343.30 | $551.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.30 / $346.92 / $433.64
| Professional | | $343.30 | $346.92 | $433.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.78 / $216.82 / $361.37
| Professional | | $151.78 | $216.82 | $361.37 |