- 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
- $2,167.13 / $3,018.11 / $3,543.25
| Professional | | $2,167.13 | $3,018.11 | $3,543.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,597.04 / $3,246.29 / $3,437.25
| Professional | | $2,597.04 | $3,246.29 | $3,437.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,700.07 / $3,742.55 / $4,561.47
| Professional | | $2,700.07 | $3,742.55 | $4,561.47 |
- 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
- $2,002.23 / $2,728.62 / $4,638.66
| Professional | | $2,002.23 | $2,728.62 | $4,638.66 |