- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.42 / $4,625.13 / $6,008.71
| Facility | | $2,016.42 | $4,625.13 | $6,008.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,036.59 / $6,049.88
| Professional | | $2,016.42 | $2,036.59 | $6,049.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,859.49 / $2,187.63 / $8,639.91
| Facility | | $1,859.49 | $2,187.63 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,092.51 / $2,092.51 / $2,092.51
| Professional | | $2,092.51 | $2,092.51 | $2,092.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.29 / $2,016.42 / $2,016.42
| Facility | | $1,902.29 | $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 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,996.32 / $4,901.84 / $6,008.71
| Facility | | $1,996.32 | $4,901.84 | $6,008.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,996.32 / $2,036.59 / $6,008.71
| Professional | | $1,996.32 | $2,036.59 | $6,008.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.29 / $2,016.42 / $2,016.42
| Facility | | $1,902.29 | $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 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,825.83 / $1,825.83 / $2,118.66
| Facility | | $1,825.83 | $1,825.83 | $2,118.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,825.83 / $1,825.83 / $2,118.66
| Professional | | $1,825.83 | $1,825.83 | $2,118.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,016.42 / $2,631.43
| Professional | | $2,016.42 | $2,016.42 | $2,631.43 |