- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $447.99 / $639.98 / $713.24
| Facility | | $447.99 | $639.98 | $713.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.99 / $639.98 / $735.98
| Professional | | $447.99 | $639.98 | $735.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.45 / $293.45 / $293.45
| Professional | | $293.45 | $293.45 | $293.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.80 / $478.80 / $798.00
| Professional | | $478.80 | $478.80 | $798.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.47 / $88.47 / $88.47
| Professional | | $88.47 | $88.47 | $88.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.89 / $1,010.43 / $1,839.39
| Professional | | $489.89 | $1,010.43 | $1,839.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.40 / $642.40 / $642.40
| Professional | | $642.40 | $642.40 | $642.40 |