- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $914.97
| Professional | | $529.89 | $529.89 | $914.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.87 / $599.87 / $599.87
| Facility | | $599.87 | $599.87 | $599.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $499.90 / $593.85 / $989.75
| Facility | | $499.90 | $593.85 | $989.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $529.89
| Professional | | $529.89 | $529.89 | $529.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $499.90 / $593.85 / $989.75
| Facility | | $499.90 | $593.85 | $989.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $529.89
| Professional | | $529.89 | $529.89 | $529.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.13 / $529.89 / $561.67
| Professional | | $491.13 | $529.89 | $561.67 |