- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $1,688.00 / $3,109.00
| Facility | | $1,233.00 | $1,688.00 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,001.00 / $1,337.87 / $1,572.53
| Professional | | $1,001.00 | $1,337.87 | $1,572.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,177.65 / $1,472.06 / $1,558.66
| Professional | | $1,177.65 | $1,472.06 | $1,558.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,166.22 / $1,690.00 / $2,064.32
| Professional | | $1,166.22 | $1,690.00 | $2,064.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.00 / $4,334.00 / $8,676.00
| Facility | | $2,104.00 | $4,334.00 | $8,676.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.70 / $1,509.46 / $2,236.64
| Professional | | $1,010.70 | $1,509.46 | $2,236.64 |