- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.57 / $351.51 / $1,400.00
| Facility | | $278.57 | $351.51 | $1,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.32 / $317.20 / $400.14
| Professional | | $248.32 | $317.20 | $400.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.81 / $379.27 / $413.22
| Facility | | $327.81 | $379.27 | $413.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.31 / $367.31 / $367.31
| Professional | | $367.31 | $367.31 | $367.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.63 / $525.63 / $525.63
| Facility | | $525.63 | $525.63 | $525.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.93 / $459.13 / $1,445.28
| Professional | | $323.93 | $459.13 | $1,445.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.36 / $462.38 / $661.45
| Professional | | $314.36 | $462.38 | $661.45 |