- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,342.00 / $2,477.00 / $3,900.04
| Facility | | $1,342.00 | $2,477.00 | $3,900.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,951.75 / $2,573.39 / $3,031.66
| Professional | | $1,951.75 | $2,573.39 | $3,031.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,369.36 / $2,961.71 / $3,135.92
| Professional | | $2,369.36 | $2,961.71 | $3,135.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,066.27 / $3,155.18 / $4,142.80
| Professional | | $2,066.27 | $3,155.18 | $4,142.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,896.00 / $5,455.00 / $12,000.00
| Facility | | $2,896.00 | $5,455.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,831.15 / $2,410.79 / $4,183.22
| Professional | | $1,831.15 | $2,410.79 | $4,183.22 |