- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.95 / $416.66 / $421.94
| Professional | | $306.95 | $416.66 | $421.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.39 / $502.81 / $635.29
| Professional | | $427.39 | $502.81 | $635.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.54 / $502.54 / $502.54
| Facility | | $502.54 | $502.54 | $502.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.16 / $502.54 / $502.54
| Professional | | $427.16 | $502.54 | $502.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.90 / $444.69 / $584.13
| Professional | | $329.90 | $444.69 | $584.13 |