- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.00 / $1,544.47 / $3,728.00
| Facility | | $646.00 | $1,544.47 | $3,728.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,426.22 / $1,479.91 / $1,687.10
| Professional | | $1,426.22 | $1,479.91 | $1,687.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,096.39 / $5,377.00 / $7,780.08
| Facility | | $3,096.39 | $5,377.00 | $7,780.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,585.00
| Facility | | $746.00 | $2,415.00 | $6,585.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,361.37 / $1,925.45 / $3,269.31
| Professional | | $1,361.37 | $1,925.45 | $3,269.31 |