- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.50 / $355.30 / $456.00
| Facility | | $313.50 | $355.30 | $456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.00 / $456.00 / $456.00
| Professional | | $456.00 | $456.00 | $456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.12 / $397.91 / $475.00
| Professional | | $358.12 | $397.91 | $475.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.00 / $456.00 / $532.00
| Professional | | $418.00 | $456.00 | $532.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.00 / $456.00 / $570.00
| Professional | | $380.00 | $456.00 | $570.00 |