- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,342.00 / $2,147.19 / $3,324.00
| Facility | | $1,342.00 | $2,147.19 | $3,324.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,617.54 / $2,123.67 / $2,586.02
| Professional | | $1,617.54 | $2,123.67 | $2,586.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,878.37 / $2,347.96 / $2,486.08
| Professional | | $1,878.37 | $2,347.96 | $2,486.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,803.41 / $2,624.71 / $3,280.89
| Professional | | $1,803.41 | $2,624.71 | $3,280.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $3,635.00 / $8,676.00
| Facility | | $2,000.00 | $3,635.00 | $8,676.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,586.37 / $2,033.13 / $3,298.61
| Professional | | $1,586.37 | $2,033.13 | $3,298.61 |