- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.71 / $734.20 / $1,270.53
| Facility | | $520.71 | $734.20 | $1,270.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.69 / $508.46 / $520.71
| Professional | | $422.69 | $508.46 | $520.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.71 / $612.60 / $673.86
| Facility | | $520.71 | $612.60 | $673.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.71 / $520.71 / $520.71
| Professional | | $520.71 | $520.71 | $520.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.46 / $2,290.57 / $13,785.00
| Facility | | $508.46 | $2,290.57 | $13,785.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.71 / $520.71 / $520.71
| Professional | | $520.71 | $520.71 | $520.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.50 / $510.50 / $612.60
| Professional | | $510.50 | $510.50 | $612.60 |