- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.42 / $3,939.11 / $5,007.41
| Facility | | $2,016.42 | $3,939.11 | $5,007.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,016.42 / $2,391.63
| Professional | | $2,016.42 | $2,016.42 | $2,391.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.06 / $3,540.43 / $6,452.54
| Facility | | $2,218.06 | $3,540.43 | $6,452.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,016.42 / $2,016.42
| Professional | | $2,016.42 | $2,016.42 | $2,016.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.29 / $1,902.29 / $2,919.48
| Facility | | $1,902.29 | $1,902.29 | $2,919.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,016.42 / $2,016.42
| Professional | | $2,016.42 | $2,016.42 | $2,016.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,976.55 / $2,137.41 / $3,344.84
| Facility | | $1,976.55 | $2,137.41 | $3,344.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,512.32 / $2,218.07 / $3,055.00
| Professional | | $1,512.32 | $2,218.07 | $3,055.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,016.42 / $2,016.42
| Professional | | $2,016.42 | $2,016.42 | $2,016.42 |