- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,016.42 / $3,557.79
| Facility | | $2,016.42 | $2,016.42 | $3,557.79 |
- 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
- $2,187.63 / $2,198.57 / $2,226.79
| Facility | | $2,187.63 | $2,198.57 | $2,226.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,859.49 / $2,195.29 / $2,214.98
| Professional | | $1,859.49 | $2,195.29 | $2,214.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,961.55 / $1,981.17 / $2,451.94
| Professional | | $1,961.55 | $1,981.17 | $2,451.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,976.55 / $2,540.81 / $5,929.65
| Facility | | $1,976.55 | $2,540.81 | $5,929.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,925.23 / $1,976.55 / $2,146.63
| Professional | | $1,925.23 | $1,976.55 | $2,146.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,713.96 / $2,016.42 / $2,189.92
| Professional | | $1,713.96 | $2,016.42 | $2,189.92 |