- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $1,869.53 / $9,034.00
| Facility | | $1,277.00 | $1,869.53 | $9,034.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,386.70 / $1,839.82 / $2,201.48
| Professional | | $1,386.70 | $1,839.82 | $2,201.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,622.94 / $2,028.67 / $2,148.00
| Professional | | $1,622.94 | $2,028.67 | $2,148.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,684.79 / $2,360.00 / $2,847.86
| Professional | | $1,684.79 | $2,360.00 | $2,847.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.00 / $2,311.00 / $5,626.00
| Facility | | $1,240.00 | $2,311.00 | $5,626.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,404.75 / $1,856.85 / $2,879.97
| Professional | | $1,404.75 | $1,856.85 | $2,879.97 |