- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,901.86 / $2,866.52 / $5,110.35
| Facility | | $1,901.86 | $2,866.52 | $5,110.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,901.86 / $1,901.86 / $1,901.86
| Professional | | $1,901.86 | $1,901.86 | $1,901.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,883.02 / $2,899.98 / $6,675.38
| Facility | | $1,883.02 | $2,899.98 | $6,675.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.72 / $1,828.72 / $1,828.72
| Professional | | $1,828.72 | $1,828.72 | $1,828.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,828.71 / $1,828.71 / $1,828.71
| Facility | | $1,828.71 | $1,828.71 | $1,828.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.71 / $1,828.71 / $1,828.71
| Professional | | $1,828.71 | $1,828.71 | $1,828.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,897.72 / $1,983.98 / $2,287.62
| Professional | | $1,897.72 | $1,983.98 | $2,287.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,645.85 / $1,828.72 / $3,530.59
| Professional | | $1,645.85 | $1,828.72 | $3,530.59 |