- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.99 / $400.99 / $400.99
| Facility | | $400.99 | $400.99 | $400.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.93 / $98.09 / $372.00
| Professional | | $85.93 | $98.09 | $372.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64,999.99 / $81,499.99 / $94,999.99
| Facility | | $64,999.99 | $81,499.99 | $94,999.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Professional | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $153.13
| Facility | | $128.82 | $128.82 | $153.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.01 / $128.82 / $193.46
| Professional | | $95.01 | $128.82 | $193.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.17 / $87.36 / $128.82
| Facility | | $75.17 | $87.36 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.01 / $157.94 / $204.35
| Professional | | $95.01 | $157.94 | $204.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.36 / $149.91 / $184.11
| Professional | | $126.36 | $149.91 | $184.11 |