- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.07 / $1,688.00 / $3,109.00
| Facility | | $1,200.07 | $1,688.00 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $997.55 / $1,244.47 / $1,502.10
| Professional | | $997.55 | $1,244.47 | $1,502.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,172.84 / $1,466.06 / $1,552.30
| Professional | | $1,172.84 | $1,466.06 | $1,552.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,119.51 / $1,548.10 / $2,037.64
| Professional | | $1,119.51 | $1,548.10 | $2,037.64 |
- 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
- $962.14 / $1,295.74 / $2,057.52
| Professional | | $962.14 | $1,295.74 | $2,057.52 |