- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.00 / $1,728.00 / $3,033.07
| Facility | | $960.00 | $1,728.00 | $3,033.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,489.64 / $3,033.07 / $3,033.07
| Professional | | $1,489.64 | $3,033.07 | $3,033.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,426.42 / $1,954.00 / $2,305.71
| Professional | | $1,426.42 | $1,954.00 | $2,305.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,296.07 / $1,714.62 / $4,561.87
| Professional | | $1,296.07 | $1,714.62 | $4,561.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.00 / $1,754.00 / $5,201.00
| Facility | | $650.00 | $1,754.00 | $5,201.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,243.20 / $1,563.54 / $2,494.91
| Professional | | $1,243.20 | $1,563.54 | $2,494.91 |