- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $2,477.00 / $9,034.00
| Facility | | $1,277.00 | $2,477.00 | $9,034.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,025.00 / $2,801.84 / $3,244.95
| Professional | | $2,025.00 | $2,801.84 | $3,244.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,414.76 / $3,018.45 / $3,196.01
| Professional | | $2,414.76 | $3,018.45 | $3,196.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,507.71 / $3,609.82 / $4,240.27
| Professional | | $2,507.71 | $3,609.82 | $4,240.27 |
- 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
- $2,065.23 / $2,667.35 / $4,312.72
| Professional | | $2,065.23 | $2,667.35 | $4,312.72 |