- 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 / $399.50 / $424.47
| Professional | | $399.50 | $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
- $399.50 / $599.25 / $759.05
| Facility | | $399.50 | $599.25 | $759.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.42 / $499.42 / $514.40
| Professional | | $499.42 | $499.42 | $514.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.48 / $499.42 / $499.42
| Professional | | $449.48 | $499.42 | $499.42 |