- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $3,090.30
| Facility | | $2,137.96 | $2,137.96 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,089.30 / $2,511.89
| Professional | | $2,041.74 | $2,089.30 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,818.38 / $7,585.78
| Facility | | $1,778.28 | $2,818.38 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,238.72 / $5,623.41
| Professional | | $2,089.30 | $2,238.72 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,897.79 / $7,762.47
| Facility | | $2,818.38 | $4,897.79 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Professional | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,884.03 / $7,079.46
| Facility | | $851.14 | $2,884.03 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,090.30 / $4,466.84
| Professional | | $2,570.40 | $3,090.30 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $3,548.13
| Professional | | $2,137.96 | $2,137.96 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,818.38 / $7,585.78
| Facility | | $1,778.28 | $2,818.38 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,238.72 / $5,623.41
| Professional | | $2,089.30 | $2,238.72 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $831.76 / $1,659.59
| Facility | | $776.25 | $831.76 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,137.96 / $2,951.21
| Professional | | $2,089.30 | $2,137.96 | $2,951.21 |