- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $2,050.57 / $3,109.00
| Facility | | $1,233.00 | $2,050.57 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,497.84 / $1,873.95 / $2,535.94
| Professional | | $1,497.84 | $1,873.95 | $2,535.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,746.01 / $2,182.51 / $2,310.89
| Professional | | $1,746.01 | $2,182.51 | $2,310.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,752.87 / $2,688.20 / $3,062.30
| Professional | | $1,752.87 | $2,688.20 | $3,062.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.00 / $4,555.00 / $8,929.00
| Facility | | $2,104.00 | $4,555.00 | $8,929.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,592.50 / $2,276.28 / $3,213.46
| Professional | | $1,592.50 | $2,276.28 | $3,213.46 |