- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $1,702.77 / $9,034.00
| Facility | | $1,277.00 | $1,702.77 | $9,034.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,198.75 / $1,449.31 / $1,967.87
| Professional | | $1,198.75 | $1,449.31 | $1,967.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,456.73 / $1,820.91 / $1,928.03
| Professional | | $1,456.73 | $1,820.91 | $1,928.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,520.84 / $2,063.91 / $2,551.15
| Professional | | $1,520.84 | $2,063.91 | $2,551.15 |
- 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
- $1,241.16 / $1,640.61 / $2,615.05
| Professional | | $1,241.16 | $1,640.61 | $2,615.05 |