- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $1,782.00 / $9,034.00
| Facility | | $1,277.00 | $1,782.00 | $9,034.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.49 / $1,475.71 / $1,982.44
| Professional | | $1,274.49 | $1,475.71 | $1,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,517.07 / $1,896.34 / $2,007.89
| Professional | | $1,517.07 | $1,896.34 | $2,007.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,590.72 / $2,143.23 / $2,658.78
| Professional | | $1,590.72 | $2,143.23 | $2,658.78 |
- 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
- $1,294.85 / $1,649.60 / $2,711.93
| Professional | | $1,294.85 | $1,649.60 | $2,711.93 |