- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,914.00 / $2,491.81 / $3,319.48
| Professional | | $1,914.00 | $2,491.81 | $3,319.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,500.22 / $11,446.13 / $13,055.82
| Facility | | $3,500.22 | $11,446.13 | $13,055.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.26 / $266.26 / $266.26
| Professional | | $266.26 | $266.26 | $266.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,079.47 / $4,079.47 / $4,079.47
| Facility | | $4,079.47 | $4,079.47 | $4,079.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,672.64 / $2,672.64 / $3,407.14
| Facility | | $2,672.64 | $2,672.64 | $3,407.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,271.73 / $2,672.64 / $3,492.32
| Professional | | $2,271.73 | $2,672.64 | $3,492.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,853.51 / $19,176.53 / $19,377.48
| Facility | | $6,853.51 | $19,176.53 | $19,377.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,496.69 / $2,744.60 / $4,079.47
| Facility | | $2,496.69 | $2,744.60 | $4,079.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.95 / $3,460.60 / $4,079.47
| Professional | | $407.95 | $3,460.60 | $4,079.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,496.69 / $2,672.64 / $4,079.47
| Facility | | $2,496.69 | $2,672.64 | $4,079.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,271.73 / $2,672.64 / $3,460.60
| Professional | | $2,271.73 | $2,672.64 | $3,460.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.26 / $2,039.49 / $3,108.11
| Professional | | $1,584.26 | $2,039.49 | $3,108.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,808.37 / $3,129.41 / $3,129.41
| Professional | | $2,808.37 | $3,129.41 | $3,129.41 |