- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,122.02 / $3,090.30
| Facility | | $562.34 | $1,122.02 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $707.95 / $2,398.83
| Professional | | $562.34 | $707.95 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $776.25 / $1,584.89
| Facility | | $616.60 | $776.25 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $851.14
| Professional | | $562.34 | $562.34 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $562.34 / $1,230.27
| Facility | | $537.03 | $562.34 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $575.44 / $724.44
| Professional | | $562.34 | $575.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $630.96 / $1,230.27
| Facility | | $562.34 | $630.96 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $812.83
| Professional | | $562.34 | $562.34 | $812.83 |