- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,833.00 / $3,666.78 / $7,119.04
| Facility | | $2,833.00 | $3,666.78 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.72 / $1,379.04 / $2,221.32
| Professional | | $925.72 | $1,379.04 | $2,221.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,084.99 / $2,495.69 / $9,495.24
| Facility | | $1,084.99 | $2,495.69 | $9,495.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $2,869.18 / $3,914.66
| Facility | | $1,481.00 | $2,869.18 | $3,914.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |