- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.99 / $258.99 / $298.83
| Professional | | $258.99 | $258.99 | $298.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.16 / $306.16 / $390.08
| Facility | | $306.16 | $306.16 | $390.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.50 / $306.16 / $326.39
| Professional | | $223.50 | $306.16 | $326.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.16 / $306.16 / $390.08
| Facility | | $306.16 | $306.16 | $390.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.50 / $306.16 / $326.39
| Professional | | $223.50 | $306.16 | $326.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.52 / $314.39 / $613.54
| Professional | | $176.52 | $314.39 | $613.54 |