- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.66 / $271.66 / $277.33
| Facility | | $271.66 | $271.66 | $277.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.42 / $265.00 / $328.62
| Professional | | $228.42 | $265.00 | $328.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.01 / $328.56 / $483.57
| Professional | | $240.01 | $328.56 | $483.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.00 / $370.28 / $503.08
| Professional | | $277.00 | $370.28 | $503.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.74 / $291.20 / $450.83
| Facility | | $244.74 | $291.20 | $450.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.33 / $354.79 / $549.66
| Professional | | $262.33 | $354.79 | $549.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.62 / $400.06 / $653.74
| Professional | | $284.62 | $400.06 | $653.74 |