- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.44 / $345.54 / $1,200.00
| Facility | | $249.44 | $345.54 | $1,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.62 / $277.82 / $386.01
| Professional | | $246.62 | $277.82 | $386.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.92 / $267.58 / $291.55
| Facility | | $245.92 | $267.58 | $291.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.77 / $259.14 / $259.14
| Professional | | $146.77 | $259.14 | $259.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.33 / $394.33 / $394.33
| Facility | | $394.33 | $394.33 | $394.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.34 / $354.17 / $786.82
| Professional | | $231.34 | $354.17 | $786.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.44 / $330.72 / $445.09
| Professional | | $219.44 | $330.72 | $445.09 |