- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.74 / $325.92 / $325.92
| Facility | | $260.74 | $325.92 | $325.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.74 / $260.74 / $325.92
| Professional | | $260.74 | $260.74 | $325.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.06 / $304.07 / $320.07
| Facility | | $272.06 | $304.07 | $320.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.02 / $277.02 / $277.02
| Professional | | $277.02 | $277.02 | $277.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.02 / $277.02 / $277.02
| Facility | | $277.02 | $277.02 | $277.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.02 / $277.02 / $277.02
| Professional | | $277.02 | $277.02 | $277.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.11 / $307.20 / $389.00
| Facility | | $241.11 | $307.20 | $389.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.60 / $271.60 / $319.39
| Professional | | $271.60 | $271.60 | $319.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.60 / $271.60 / $305.74
| Professional | | $271.60 | $271.60 | $305.74 |