- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.42 / $3,875.76 / $4,457.10
| Facility | | $2,016.42 | $3,875.76 | $4,457.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,016.42 / $6,049.88
| Professional | | $2,016.42 | $2,016.42 | $6,049.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.09 / $2,168.65 / $2,282.79
| Facility | | $1,712.09 | $2,168.65 | $2,282.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,125.78 / $2,215.28 / $2,282.79
| Professional | | $2,125.78 | $2,215.28 | $2,282.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,961.55 / $2,016.42 / $2,451.94
| Professional | | $1,961.55 | $2,016.42 | $2,451.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,887.11 / $1,976.55 / $9,626.15
| Facility | | $1,887.11 | $1,976.55 | $9,626.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,925.23 / $1,976.55 / $2,174.21
| Professional | | $1,925.23 | $1,976.55 | $2,174.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,192.80 / $2,897.72 / $4,539.75
| Facility | | $2,192.80 | $2,897.72 | $4,539.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,009.76 / $2,371.86 / $4,264.76
| Professional | | $2,009.76 | $2,371.86 | $4,264.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,016.42 / $2,016.42
| Facility | | $2,016.42 | $2,016.42 | $2,016.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,915.60 / $2,016.42 / $2,218.06
| Professional | | $1,915.60 | $2,016.42 | $2,218.06 |