- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $1,688.00 / $3,109.00
| Facility | | $1,277.00 | $1,688.00 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,185.21 / $1,501.62 / $1,657.44
| Professional | | $1,185.21 | $1,501.62 | $1,657.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.22 / $1,726.17 / $1,726.17
| Professional | | $1,304.22 | $1,726.17 | $1,726.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,437.13 / $2,050.00 / $2,287.06
| Professional | | $1,437.13 | $2,050.00 | $2,287.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,758.00 / $5,455.00 / $12,000.00
| Facility | | $2,758.00 | $5,455.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,125.05 / $1,330.98 / $2,443.73
| Professional | | $1,125.05 | $1,330.98 | $2,443.73 |