- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.50 / $399.50 / $399.50
| Facility | | $399.50 | $399.50 | $399.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.57 / $399.50 / $424.47
| Professional | | $344.57 | $399.50 | $424.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.47 / $424.47 / $424.47
| Facility | | $424.47 | $424.47 | $424.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.47 / $424.47 / $424.47
| Professional | | $424.47 | $424.47 | $424.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.47 / $424.47 / $424.47
| Facility | | $424.47 | $424.47 | $424.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.47 / $424.47 / $424.47
| Professional | | $424.47 | $424.47 | $424.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.50 / $479.40 / $615.23
| Facility | | $399.50 | $479.40 | $615.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.00 / $155.00 / $329.00
| Professional | | $155.00 | $155.00 | $329.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.42 / $499.42 / $499.42
| Professional | | $499.42 | $499.42 | $499.42 |