- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $4,917.20 / $8,042.03
| Facility | | $3,468.00 | $4,917.20 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.81 / $1,840.34 / $3,166.21
| Professional | | $1,054.81 | $1,840.34 | $3,166.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.25 / $2,808.82 / $6,608.00
| Facility | | $2,104.25 | $2,808.82 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.65 / $2,616.94 / $3,422.79
| Facility | | $1,749.65 | $2,616.94 | $3,422.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |