- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.36 / $307.36 / $1,600.00
| Facility | | $307.36 | $307.36 | $1,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.08 / $307.36 / $365.67
| Professional | | $276.08 | $307.36 | $365.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.32 / $321.32 / $392.22
| Facility | | $321.32 | $321.32 | $392.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.64 / $348.64 / $348.64
| Professional | | $348.64 | $348.64 | $348.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.31 / $346.31 / $346.31
| Facility | | $346.31 | $346.31 | $346.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.47 / $407.20 / $833.74
| Professional | | $283.47 | $407.20 | $833.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.35 / $344.27 / $559.88
| Professional | | $235.35 | $344.27 | $559.88 |