- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.48 / $1,895.46 / $7,686.63
| Facility | | $376.48 | $1,895.46 | $7,686.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.51 / $377.52 / $481.89
| Professional | | $377.51 | $377.52 | $481.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.48 / $376.48 / $377.52
| Professional | | $376.48 | $376.48 | $377.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.52 / $377.52 / $480.81
| Professional | | $377.52 | $377.52 | $480.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.52 / $377.52 / $394.53
| Professional | | $377.52 | $377.52 | $394.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.52 / $420.26 / $458.23
| Professional | | $377.52 | $420.26 | $458.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.97 / $369.97 / $369.97
| Professional | | $369.97 | $369.97 | $369.97 |