- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.07 / $3,253.14 / $4,111.22
| Facility | | $2,218.07 | $3,253.14 | $4,111.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,996.32 / $2,218.07 / $2,391.63
| Professional | | $1,996.32 | $2,218.07 | $2,391.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,887.11 / $2,942.34 / $5,688.52
| Facility | | $1,887.11 | $2,942.34 | $5,688.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,041.16 / $2,540.81
| Professional | | $2,016.42 | $2,041.16 | $2,540.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.29 / $1,902.29 / $4,684.64
| Facility | | $1,902.29 | $1,902.29 | $4,684.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,016.42 / $2,472.96
| Professional | | $2,016.42 | $2,016.42 | $2,472.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,961.56 / $2,016.42 / $4,102.28
| Facility | | $1,961.56 | $2,016.42 | $4,102.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.40 / $3,019.38 / $5,283.92
| Facility | | $1,698.40 | $3,019.38 | $5,283.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,895.36 / $2,095.83 / $2,419.82
| Professional | | $1,895.36 | $2,095.83 | $2,419.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,886.37 / $2,353.87 / $4,367.41
| Facility | | $1,886.37 | $2,353.87 | $4,367.41 |
- 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 / $2,016.42 / $2,016.42
| Facility | | $1,925.23 | $2,016.42 | $2,016.42 |
- 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 |