- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.43 / $327.43 / $327.43
| Facility | | $327.43 | $327.43 | $327.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.99 / $327.43 / $390.48
| Professional | | $319.99 | $327.43 | $390.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.31 / $310.31 / $310.31
| Professional | | $310.31 | $310.31 | $310.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.69 / $713.69 / $713.69
| Professional | | $713.69 | $713.69 | $713.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.42 / $327.43 / $553.36
| Facility | | $256.42 | $327.43 | $553.36 |