- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,085.11 / $1,821.00 / $3,109.00
| Facility | | $1,085.11 | $1,821.00 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,085.10 / $1,085.11 / $1,128.95
| Professional | | $1,085.10 | $1,085.11 | $1,128.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,300.93 / $5,300.93 / $6,043.06
| Facility | | $5,300.93 | $5,300.93 | $6,043.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.00 / $541.00 / $3,840.03
| Facility | | $515.00 | $541.00 | $3,840.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.00 / $2,920.00 / $9,202.79
| Facility | | $1,565.00 | $2,920.00 | $9,202.79 |