- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,789.55 / $1,969.89 / $1,989.59
| Facility | | $1,789.55 | $1,969.89 | $1,989.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,969.89 / $1,969.89 / $2,048.67
| Professional | | $1,969.89 | $1,969.89 | $2,048.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.96 / $1,773.27 / $1,969.89
| Professional | | $563.96 | $1,773.27 | $1,969.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.03 / $1,858.38 / $2,296.02
| Facility | | $422.03 | $1,858.38 | $2,296.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,969.89 / $1,969.89 / $1,969.89
| Professional | | $1,969.89 | $1,969.89 | $1,969.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $1,969.89 / $4,181.35
| Facility | | $319.00 | $1,969.89 | $4,181.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,674.41 / $1,969.89 / $2,044.22
| Professional | | $1,674.41 | $1,969.89 | $2,044.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,969.89 / $1,969.89 / $2,044.22
| Facility | | $1,969.89 | $1,969.89 | $2,044.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,969.89 / $2,044.22 / $2,044.22
| Professional | | $1,969.89 | $2,044.22 | $2,044.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.03 / $1,858.38 / $2,296.02
| Facility | | $422.03 | $1,858.38 | $2,296.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,969.89 / $1,969.89 / $1,969.89
| Professional | | $1,969.89 | $1,969.89 | $1,969.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,969.89 / $1,969.89 / $2,954.84
| Professional | | $1,969.89 | $1,969.89 | $2,954.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,044.22 / $2,044.22 / $2,044.22
| Facility | | $2,044.22 | $2,044.22 | $2,044.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,969.89 / $2,044.22 / $2,044.22
| Professional | | $1,969.89 | $2,044.22 | $2,044.22 |