- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,294.14 / $4,294.16 / $9,025.76
| Facility | | $4,294.14 | $4,294.16 | $9,025.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,041.56 / $4,294.16 / $4,294.16
| Professional | | $4,041.56 | $4,294.16 | $4,294.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,294.16 / $4,294.16 / $4,294.16
| Facility | | $4,294.16 | $4,294.16 | $4,294.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,294.16 / $4,294.16 / $4,294.16
| Professional | | $4,294.16 | $4,294.16 | $4,294.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,650.04 / $4,294.16 / $4,294.16
| Professional | | $3,650.04 | $4,294.16 | $4,294.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,480.51 / $3,480.51 / $3,480.51
| Facility | | $3,480.51 | $3,480.51 | $3,480.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,294.14 / $5,453.58 / $9,025.76
| Facility | | $4,294.14 | $5,453.58 | $9,025.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,041.56 / $4,294.16 / $5,453.58
| Professional | | $4,041.56 | $4,294.16 | $5,453.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,069.54 / $8,694.29 / $13,465.88
| Professional | | $2,069.54 | $8,694.29 | $13,465.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,294.16 / $4,294.16 / $4,294.16
| Facility | | $4,294.16 | $4,294.16 | $4,294.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,294.16 / $4,294.16 / $4,294.16
| Professional | | $4,294.16 | $4,294.16 | $4,294.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,076.93 / $4,076.93 / $4,484.62
| Facility | | $4,076.93 | $4,076.93 | $4,484.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,076.93 / $4,076.93 / $4,484.62
| Professional | | $4,076.93 | $4,076.93 | $4,484.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,209.96 / $4,209.96 / $5,945.89
| Professional | | $4,209.96 | $4,209.96 | $5,945.89 |