- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.44 / $1,940.40 / $1,940.40
| Facility | | $558.44 | $1,940.40 | $1,940.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,362.49 / $1,592.18 / $2,442.44
| Facility | | $1,362.49 | $1,592.18 | $2,442.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.53 / $558.44 / $942.00
| Facility | | $471.53 | $558.44 | $942.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.67 / $558.44 / $1,040.35
| Facility | | $474.67 | $558.44 | $1,040.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.53 / $554.62 / $942.00
| Facility | | $471.53 | $554.62 | $942.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.10 / $1,201.69 / $1,713.80
| Professional | | $848.10 | $1,201.69 | $1,713.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.32 / $1,050.04 / $2,358.53
| Facility | | $594.32 | $1,050.04 | $2,358.53 |