- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.07 / $5,549.00 / $7,119.04
| Facility | | $750.07 | $5,549.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.16 / $1,228.33 / $2,276.60
| Professional | | $752.16 | $1,228.33 | $2,276.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.75 / $1,712.43 / $4,299.06
| Facility | | $1,026.75 | $1,712.43 | $4,299.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,218.29 / $1,823.85 / $2,554.94
| Facility | | $1,218.29 | $1,823.85 | $2,554.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.00 / $5,847.00 / $7,856.00
| Facility | | $1,321.00 | $5,847.00 | $7,856.00 |