- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,831.39 / $2,116.32 / $4,677.10
| Facility | | $1,831.39 | $2,116.32 | $4,677.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,116.32 / $2,116.32 / $2,137.48
| Professional | | $2,116.32 | $2,116.32 | $2,137.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,996.53 / $2,253.63 / $2,916.46
| Facility | | $1,996.53 | $2,253.63 | $2,916.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,116.32 / $2,116.32 / $2,116.32
| Professional | | $2,116.32 | $2,116.32 | $2,116.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,525.79 / $8,702.00 / $13,785.00
| Facility | | $3,525.79 | $8,702.00 | $13,785.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,097.44 / $2,113.23 / $2,113.23
| Professional | | $2,097.44 | $2,113.23 | $2,113.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,536.03 / $2,536.03 / $2,536.03
| Facility | | $2,536.03 | $2,536.03 | $2,536.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,116.32 / $2,116.32 / $2,426.55
| Professional | | $2,116.32 | $2,116.32 | $2,426.55 |