- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,976.55 / $2,016.42 / $3,427.91
| Facility | | $1,976.55 | $2,016.42 | $3,427.91 |
- 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
- $2,282.75 / $2,377.86 / $4,032.84
| Facility | | $2,282.75 | $2,377.86 | $4,032.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,713.95 / $2,016.42 / $2,016.42
| Professional | | $1,713.95 | $2,016.42 | $2,016.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,218.06 / $3,226.27
| Facility | | $2,016.42 | $2,218.06 | $3,226.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,218.06 / $3,112.49
| Professional | | $2,016.42 | $2,218.06 | $3,112.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,016.42 / $2,159.69
| Facility | | $2,016.42 | $2,016.42 | $2,159.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,672.45 / $2,016.42 / $3,701.06
| Professional | | $1,672.45 | $2,016.42 | $3,701.06 |
- 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 |