- 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
- $1,051.04 / $1,422.34 / $1,669.35
| Professional | | $1,051.04 | $1,422.34 | $1,669.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,248.86 / $1,561.08 / $1,652.91
| Professional | | $1,248.86 | $1,561.08 | $1,652.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,278.63 / $1,826.54 / $2,191.01
| Professional | | $1,278.63 | $1,826.54 | $2,191.01 |
- 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
- $1,060.54 / $1,361.92 / $2,214.19
| Professional | | $1,060.54 | $1,361.92 | $2,214.19 |