- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,809.44 / $1,809.44 / $2,080.86
| Facility | | $1,809.44 | $1,809.44 | $2,080.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,808.65 / $1,989.51 / $2,260.81
| Professional | | $1,808.65 | $1,989.51 | $2,260.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,706.27 / $1,808.65 / $1,808.65
| Facility | | $1,706.27 | $1,808.65 | $1,808.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,808.65 / $1,808.65 / $1,808.65
| Professional | | $1,808.65 | $1,808.65 | $1,808.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.47 / $2,260.81 / $3,232.96
| Facility | | $701.47 | $2,260.81 | $3,232.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,808.65 / $1,808.65 / $2,260.81
| Professional | | $1,808.65 | $1,808.65 | $2,260.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.14 / $2,718.21 / $4,620.96
| Facility | | $1,812.14 | $2,718.21 | $4,620.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,170.37 / $2,170.37 / $2,260.81
| Professional | | $2,170.37 | $2,170.37 | $2,260.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,808.65 / $1,808.65 / $2,532.11
| Professional | | $1,808.65 | $1,808.65 | $2,532.11 |