- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.23 / $475.23 / $548.35
| Professional | | $475.23 | $475.23 | $548.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.40 / $456.40 / $715.78
| Facility | | $456.40 | $456.40 | $715.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.17 / $456.40 / $470.09
| Professional | | $333.17 | $456.40 | $470.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.40 / $456.40 / $715.78
| Facility | | $456.40 | $456.40 | $715.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.17 / $456.40 / $470.09
| Professional | | $333.17 | $456.40 | $470.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.00 / $360.00 / $360.00
| Facility | | $360.00 | $360.00 | $360.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.86 / $549.02 / $1,125.83
| Professional | | $336.86 | $549.02 | $1,125.83 |