- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,914.55 / $4,239.50 / $8,216.25
| Facility | | $2,914.55 | $4,239.50 | $8,216.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,845.97 / $2,914.55 / $3,166.40
| Professional | | $2,845.97 | $2,914.55 | $3,166.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,914.55 / $2,914.55 / $2,914.55
| Facility | | $2,914.55 | $2,914.55 | $2,914.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,914.55 / $2,914.55 / $2,914.55
| Professional | | $2,914.55 | $2,914.55 | $2,914.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,914.55 / $2,914.55 / $3,428.88
| Professional | | $2,914.55 | $2,914.55 | $3,428.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,387.47 / $4,842.87 / $7,232.27
| Facility | | $4,387.47 | $4,842.87 | $7,232.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,914.55 / $4,430.10 / $8,656.20
| Facility | | $2,914.55 | $4,430.10 | $8,656.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,845.96 / $2,914.55 / $6,459.20
| Professional | | $2,845.96 | $2,914.55 | $6,459.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,273.04 / $4,584.38 / $6,665.85
| Professional | | $3,273.04 | $4,584.38 | $6,665.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,914.55 / $2,914.55 / $2,914.55
| Facility | | $2,914.55 | $2,914.55 | $2,914.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,914.55 / $2,914.55 / $2,914.55
| Professional | | $2,914.55 | $2,914.55 | $2,914.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,257.44 / $3,257.44 / $3,257.44
| Facility | | $3,257.44 | $3,257.44 | $3,257.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,257.44 / $3,257.44 / $3,257.44
| Professional | | $3,257.44 | $3,257.44 | $3,257.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,857.40 / $2,857.40 / $3,728.91
| Professional | | $2,857.40 | $2,857.40 | $3,728.91 |