- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,847.00 / $4,229.64 / $8,458.83
| Facility | | $1,847.00 | $4,229.64 | $8,458.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.72 / $1,847.00 / $1,861.13
| Professional | | $1,828.72 | $1,847.00 | $1,861.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,828.71 / $3,657.42 / $4,846.10
| Facility | | $1,828.71 | $3,657.42 | $4,846.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,554.41 / $1,828.71 / $2,596.76
| Professional | | $1,554.41 | $1,828.71 | $2,596.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,828.72 / $2,011.59 / $2,743.08
| Facility | | $1,828.72 | $2,011.59 | $2,743.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,011.59 / $2,011.59 / $2,011.59
| Professional | | $2,011.59 | $2,011.59 | $2,011.59 |
- 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 / $4,846.46
| Professional | | $1,828.71 | $1,828.71 | $4,846.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.72 / $1,828.72 / $3,108.82
| Professional | | $1,828.72 | $1,828.72 | $3,108.82 |