- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.27 / $320.27 / $1,400.00
| Facility | | $320.27 | $320.27 | $1,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.27 / $347.07 / $406.85
| Professional | | $320.27 | $347.07 | $406.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.65 / $374.04 / $407.51
| Facility | | $332.65 | $374.04 | $407.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.23 / $362.23 / $362.23
| Professional | | $362.23 | $362.23 | $362.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.11 / $357.11 / $357.11
| Facility | | $357.11 | $357.11 | $357.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.75 / $452.80 / $1,553.44
| Professional | | $307.75 | $452.80 | $1,553.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.49 / $343.65 / $498.29
| Professional | | $241.49 | $343.65 | $498.29 |