- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,181.00 / $1,821.00 / $3,109.00
| Facility | | $1,181.00 | $1,821.00 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.68 / $1,318.17 / $1,318.17
| Professional | | $830.68 | $1,318.17 | $1,318.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.07 / $3,206.07 / $3,206.07
| Facility | | $3,206.07 | $3,206.07 | $3,206.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.00 / $2,311.00 / $5,652.00
| Facility | | $1,240.00 | $2,311.00 | $5,652.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,222.25 / $2,183.25 / $3,275.22
| Professional | | $1,222.25 | $2,183.25 | $3,275.22 |