- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $1,928.14 / $9,034.00
| Facility | | $1,277.00 | $1,928.14 | $9,034.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,328.43 / $1,631.72 / $2,110.71
| Professional | | $1,328.43 | $1,631.72 | $2,110.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,651.40 / $2,064.25 / $2,185.67
| Professional | | $1,651.40 | $2,064.25 | $2,185.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.04 / $2,301.30 / $2,895.11
| Professional | | $1,730.04 | $2,301.30 | $2,895.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.00 / $2,828.00 / $6,992.00
| Facility | | $1,565.00 | $2,828.00 | $6,992.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,396.32 / $1,735.02 / $2,921.00
| Professional | | $1,396.32 | $1,735.02 | $2,921.00 |