- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.24 / $2,240.51 / $2,240.51
| Facility | | $650.24 | $2,240.51 | $2,240.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,585.07 / $1,852.28 / $2,841.44
| Facility | | $1,585.07 | $1,852.28 | $2,841.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.70 / $650.24 / $1,095.00
| Facility | | $552.70 | $650.24 | $1,095.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.75 / $650.24 / $1,223.97
| Facility | | $556.75 | $650.24 | $1,223.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $551.77 / $643.92 / $1,095.00
| Facility | | $551.77 | $643.92 | $1,095.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.85 / $1,389.11 / $1,981.10
| Professional | | $1,030.85 | $1,389.11 | $1,981.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.08 / $1,212.44 / $2,726.38
| Facility | | $691.08 | $1,212.44 | $2,726.38 |