- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.99 / $182.99 / $211.14
| Professional | | $182.99 | $182.99 | $211.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $839.00 / $839.00 / $1,074.51
| Facility | | $839.00 | $839.00 | $1,074.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.27 / $274.27 / $275.61
| Facility | | $274.27 | $274.27 | $275.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.18 / $233.13 / $282.50
| Professional | | $192.18 | $233.13 | $282.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.27 / $274.27 / $275.61
| Facility | | $274.27 | $274.27 | $275.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.18 / $274.27 / $282.50
| Professional | | $192.18 | $274.27 | $282.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.71 / $281.80 / $433.50
| Professional | | $129.71 | $281.80 | $433.50 |