- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $2,028.00 / $3,109.51
| Facility | | $1,277.00 | $2,028.00 | $3,109.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,589.90 / $1,960.29 / $2,424.23
| Professional | | $1,589.90 | $1,960.29 | $2,424.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,757.98 / $2,326.73 / $2,326.73
| Professional | | $1,757.98 | $2,326.73 | $2,326.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,055.80 / $2,834.71 / $3,348.99
| Professional | | $2,055.80 | $2,834.71 | $3,348.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.00 / $2,828.00 / $6,957.00
| Facility | | $1,565.00 | $2,828.00 | $6,957.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,507.05 / $2,330.48 / $3,353.60
| Professional | | $1,507.05 | $2,330.48 | $3,353.60 |