- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.79 / $293.79 / $338.99
| Professional | | $293.79 | $293.79 | $338.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.08 / $487.08 / $487.08
| Professional | | $487.08 | $487.08 | $487.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.03 / $382.03 / $442.50
| Facility | | $382.03 | $382.03 | $442.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.88 / $382.03 / $447.99
| Professional | | $278.88 | $382.03 | $447.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.03 / $382.03 / $442.50
| Facility | | $382.03 | $382.03 | $442.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.88 / $382.03 / $447.99
| Professional | | $278.88 | $382.03 | $447.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.24 / $452.45 / $696.01
| Professional | | $200.24 | $452.45 | $696.01 |