- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,168.69 / $4,570.88
| Facility | | $2,884.03 | $4,168.69 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,884.03 / $3,467.37
| Professional | | $2,754.23 | $2,884.03 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $9,120.11 / $15,135.61
| Facility | | $6,456.54 | $9,120.11 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $7,079.46
| Professional | | $2,884.03 | $2,884.03 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $6,456.54
| Facility | | $3,235.94 | $3,235.94 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,235.94 / $6,760.83
| Professional | | $2,754.23 | $3,235.94 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $2,884.03
| Facility | | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $2,884.03
| Professional | | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,818.38 / $8,511.38
| Facility | | $1,819.70 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $4,897.79
| Professional | | $2,884.03 | $2,884.03 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $9,120.11 / $15,135.61
| Facility | | $6,456.54 | $9,120.11 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $7,079.46
| Professional | | $2,884.03 | $2,884.03 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,187.76 / $4,677.35
| Facility | | $1,819.70 | $2,187.76 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $4,265.80
| Professional | | $2,884.03 | $2,884.03 | $4,265.80 |