- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.93 / $249.93 / $249.93
| Facility | | $249.93 | $249.93 | $249.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.93 / $285.54 / $285.54
| Professional | | $249.93 | $285.54 | $285.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.19 / $379.76 / $389.21
| Professional | | $321.19 | $379.76 | $389.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.25 / $399.20 / $501.97
| Professional | | $395.25 | $399.20 | $501.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.04 / $266.77 / $1,599.48
| Facility | | $150.04 | $266.77 | $1,599.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.86 / $229.35 / $277.82
| Professional | | $136.86 | $229.35 | $277.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.93 / $229.35 / $273.70
| Professional | | $101.93 | $229.35 | $273.70 |