- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,780.90 / $2,371.00 / $2,400.00
| Facility | | $1,780.90 | $2,371.00 | $2,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,199.71 / $2,954.20 / $4,355.10
| Professional | | $2,199.71 | $2,954.20 | $4,355.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,270.16 / $3,616.21 / $5,847.00
| Facility | | $2,270.16 | $3,616.21 | $5,847.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,958.00 / $4,199.87 / $5,472.15
| Facility | | $2,958.00 | $4,199.87 | $5,472.15 |
- 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 |