- 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
- $1,348.08 / $2,233.12 / $4,327.32
| Professional | | $1,348.08 | $2,233.12 | $4,327.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,935.87 / $3,596.32 / $8,342.00
| Facility | | $1,935.87 | $3,596.32 | $8,342.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,186.27 / $3,195.74 / $4,322.37
| Facility | | $2,186.27 | $3,195.74 | $4,322.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |