- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,002.27 / $1,517.32 / $2,437.53
| Professional | | $1,002.27 | $1,517.32 | $2,437.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,156.03 / $1,902.97 / $5,847.00
| Facility | | $1,156.03 | $1,902.97 | $5,847.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,486.29 / $1,893.46 / $2,430.41
| Facility | | $1,486.29 | $1,893.46 | $2,430.41 |
- 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 |