- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.99 / $175.33 / $310.99
| Facility | | $140.99 | $175.33 | $310.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.99 / $142.40 / $169.92
| Professional | | $140.99 | $142.40 | $169.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.60 / $234.60 / $448.28
| Facility | | $141.60 | $234.60 | $448.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.99 / $140.99 / $140.99
| Professional | | $140.99 | $140.99 | $140.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.01 / $140.99 / $140.99
| Facility | | $133.01 | $140.99 | $140.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.99 / $140.99 / $140.99
| Professional | | $140.99 | $140.99 | $140.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.99 / $149.44 / $174.83
| Professional | | $140.99 | $149.44 | $174.83 |