- 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
- $1,000.43 / $1,325.41 / $1,615.45
| Professional | | $1,000.43 | $1,325.41 | $1,615.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,125.07 / $1,489.07 / $1,489.07
| Professional | | $1,125.07 | $1,489.07 | $1,489.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,269.39 / $1,932.08 / $2,078.53
| Professional | | $1,269.39 | $1,932.08 | $2,078.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.00 / $2,314.00 / $5,652.00
| Facility | | $1,240.00 | $2,314.00 | $5,652.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $969.51 / $1,346.05 / $2,214.23
| Professional | | $969.51 | $1,346.05 | $2,214.23 |