- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,470.69 / $5,415.75
| Facility | | $2,016.42 | $2,470.69 | $5,415.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,016.42 / $2,036.59
| Professional | | $2,016.42 | $2,016.42 | $2,036.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,137.60 / $2,766.30
| Facility | | $2,016.42 | $2,137.60 | $2,766.30 |
- 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
- $1,925.23 / $4,283.18 / $13,785.00
| Facility | | $1,925.23 | $4,283.18 | $13,785.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,925.23 / $1,925.23 / $2,047.34
| Professional | | $1,925.23 | $1,925.23 | $2,047.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,816.65 / $1,816.65 / $1,816.65
| Facility | | $1,816.65 | $1,816.65 | $1,816.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,016.42 / $2,540.81
| Professional | | $2,016.42 | $2,016.42 | $2,540.81 |