- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $2,472.13 / $4,543.77
| Facility | | $1,277.00 | $2,472.13 | $4,543.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,974.26 / $2,619.64 / $3,117.37
| Professional | | $1,974.26 | $2,619.64 | $3,117.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,382.67 / $2,978.33 / $3,153.53
| Professional | | $2,382.67 | $2,978.33 | $3,153.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,308.82 / $3,213.78 / $4,541.87
| Professional | | $2,308.82 | $3,213.78 | $4,541.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $900.00 / $2,421.00
| Facility | | $375.00 | $900.00 | $2,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,853.10 / $2,479.23 / $4,282.02
| Professional | | $1,853.10 | $2,479.23 | $4,282.02 |