- 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
- $399.50 / $414.49 / $499.38
| Professional | | $399.50 | $414.49 | $499.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.83 / $396.88 / $429.78
| Professional | | $352.83 | $396.88 | $429.78 |
- 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 / $399.50 / $679.15
| Facility | | $399.50 | $399.50 | $679.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.42 / $499.42 / $559.35
| Professional | | $499.42 | $499.42 | $559.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.42 / $499.42 / $542.40
| Professional | | $499.42 | $499.42 | $542.40 |