- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,202.26 / $1,995.26
| Professional | | $1,148.15 | $1,202.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $21,379.62 / $33,884.42
| Facility | | $12,589.25 | $21,379.62 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,905.46 / $1,905.46
| Professional | | $1,584.89 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $21,877.62 / $26,302.68
| Facility | | $10,715.19 | $21,877.62 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,995.26 / $2,818.38
| Facility | | $1,202.26 | $1,995.26 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,089.30 / $2,454.71
| Professional | | $1,258.93 | $2,089.30 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $1,621.81
| Professional | | $30.20 | $30.20 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $20,892.96 / $27,542.29
| Facility | | $15,135.61 | $20,892.96 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,290.87 / $2,344.23
| Professional | | $1,995.26 | $2,290.87 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $28,840.32
| Professional | | $1,905.46 | $1,905.46 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,187.76 / $2,951.21
| Professional | | $1,621.81 | $2,187.76 | $2,951.21 |