- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,290.87 / $4,897.79
| Facility | | $1,862.09 | $2,290.87 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,238.72 / $3,715.35
| Professional | | $1,862.09 | $2,238.72 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,454.71 / $8,709.64
| Facility | | $1,778.28 | $2,454.71 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,630.27 / $5,128.61
| Professional | | $2,344.23 | $2,630.27 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $16,595.87
| Facility | | $2,454.71 | $2,454.71 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $6,309.57
| Professional | | $1,778.28 | $1,778.28 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,019.95 / $5,370.32
| Facility | | $1,949.84 | $3,019.95 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,187.76 / $3,388.44
| Professional | | $1,621.81 | $2,187.76 | $3,388.44 |