- 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
- $1,128.34 / $1,971.96 / $3,337.47
| Professional | | $1,128.34 | $1,971.96 | $3,337.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,163.00 / $2,985.51 / $6,608.00
| Facility | | $2,163.00 | $2,985.51 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,853.13 / $2,766.50 / $3,618.39
| Facility | | $1,853.13 | $2,766.50 | $3,618.39 |
- 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 |