- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,429.89 / $2,429.89 / $4,859.78
| Facility | | $2,429.89 | $2,429.89 | $4,859.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,429.89 / $2,429.89 / $2,928.84
| Professional | | $2,429.89 | $2,429.89 | $2,928.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,207.16 / $5,907.06 / $12,149.45
| Facility | | $2,207.16 | $5,907.06 | $12,149.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,429.89 / $2,528.26 / $10,655.19
| Professional | | $2,429.89 | $2,528.26 | $10,655.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,604.84 / $2,983.90 / $5,797.72
| Facility | | $2,604.84 | $2,983.90 | $5,797.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,429.89 / $2,429.89 / $2,429.89
| Facility | | $2,429.89 | $2,429.89 | $2,429.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,429.89 / $2,429.89 / $2,461.63
| Professional | | $2,429.89 | $2,429.89 | $2,461.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,909.00 / $3,472.00 / $8,090.00
| Facility | | $1,909.00 | $3,472.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,429.89 / $2,429.89 / $2,429.89
| Professional | | $2,429.89 | $2,429.89 | $2,429.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,429.89 / $2,429.89 / $2,429.89
| Professional | | $2,429.89 | $2,429.89 | $2,429.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82,109.37 / $82,109.37 / $82,109.37
| Facility | | $82,109.37 | $82,109.37 | $82,109.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,232.21 / $12,149.45 / $12,149.45
| Facility | | $3,232.21 | $12,149.45 | $12,149.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,429.89 / $2,575.67 / $10,655.19
| Professional | | $2,429.89 | $2,575.67 | $10,655.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,429.89 / $2,528.26 / $3,147.46
| Professional | | $2,429.89 | $2,528.26 | $3,147.46 |