- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.17 / $294.44 / $305.51
| Facility | | $226.17 | $294.44 | $305.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.04 / $295.00 / $458.91
| Professional | | $275.04 | $295.00 | $458.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.87 / $323.87 / $323.87
| Professional | | $323.87 | $323.87 | $323.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.73 / $268.02 / $384.80
| Facility | | $193.73 | $268.02 | $384.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.70 / $326.76 / $347.00
| Professional | | $274.70 | $326.76 | $347.00 |