- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,847.00 / $4,355.04 / $5,657.83
| Facility | | $1,847.00 | $4,355.04 | $5,657.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.72 / $1,847.00 / $7,974.62
| Professional | | $1,828.72 | $1,847.00 | $7,974.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,686.38 / $1,983.98 / $8,639.91
| Facility | | $1,686.38 | $1,983.98 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,897.72 / $1,897.72 / $1,897.72
| Professional | | $1,897.72 | $1,897.72 | $1,897.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,725.20 / $1,828.71 / $1,828.71
| Facility | | $1,725.20 | $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
- Facility
- Modifier
- Low / Median / High Price
- $1,879.74 / $4,355.04 / $5,657.83
| Facility | | $1,879.74 | $4,355.04 | $5,657.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.72 / $1,879.74 / $5,657.83
| Professional | | $1,828.72 | $1,879.74 | $5,657.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,725.20 / $1,828.71 / $1,828.71
| Facility | | $1,725.20 | $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
- Facility
- Modifier
- Low / Median / High Price
- $2,112.09 / $2,112.09 / $2,450.82
| Facility | | $2,112.09 | $2,112.09 | $2,450.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,112.09 / $2,112.09 / $2,450.82
| Professional | | $2,112.09 | $2,112.09 | $2,450.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.72 / $1,828.72 / $3,261.96
| Professional | | $1,828.72 | $1,828.72 | $3,261.96 |