- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.27 / $323.02 / $345.40
| Professional | | $246.27 | $323.02 | $345.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.00 / $485.00 / $513.90
| Facility | | $485.00 | $485.00 | $513.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.40 / $394.74 / $524.94
| Professional | | $345.40 | $394.74 | $524.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.00 / $445.00 / $445.00
| Facility | | $445.00 | $445.00 | $445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.52 / $344.38 / $674.98
| Professional | | $282.52 | $344.38 | $674.98 |