- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,147.13 / $1,767.55 / $3,695.66
| Professional | | $1,147.13 | $1,767.55 | $3,695.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.47 / $2,738.70 / $3,936.87
| Facility | | $1,438.47 | $2,738.70 | $3,936.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,239.52 / $2,738.70 / $3,680.49
| Facility | | $2,239.52 | $2,738.70 | $3,680.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $4,663.00 / $7,305.00
| Facility | | $3,044.00 | $4,663.00 | $7,305.00 |