- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $1,846.00 / $3,109.00
| Facility | | $1,233.00 | $1,846.00 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,336.75 / $1,833.07 / $2,171.08
| Professional | | $1,336.75 | $1,833.07 | $2,171.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,597.12 / $1,996.40 / $2,113.84
| Professional | | $1,597.12 | $1,996.40 | $2,113.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,635.65 / $2,310.00 / $2,801.82
| Professional | | $1,635.65 | $2,310.00 | $2,801.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.00 / $3,356.00 / $6,957.00
| Facility | | $1,565.00 | $3,356.00 | $6,957.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,396.31 / $1,768.00 / $2,848.20
| Professional | | $1,396.31 | $1,768.00 | $2,848.20 |