- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,977.63 / $2,739.49 / $3,520.57
| Professional | | $1,977.63 | $2,739.49 | $3,520.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.09 / $1,143.50 / $1,719.87
| Facility | | $461.09 | $1,143.50 | $1,719.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.39 / $350.45 / $350.45
| Professional | | $315.39 | $350.45 | $350.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,443.40 / $2,443.40 / $2,443.40
| Facility | | $2,443.40 | $2,443.40 | $2,443.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,446.40 / $2,446.40 / $2,937.79
| Facility | | $2,446.40 | $2,446.40 | $2,937.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,079.44 / $2,446.40 / $3,210.83
| Professional | | $2,079.44 | $2,446.40 | $3,210.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,847.72 / $4,847.72 / $4,847.72
| Facility | | $4,847.72 | $4,847.72 | $4,847.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.51 / $2,718.32 / $3,617.70
| Facility | | $366.51 | $2,718.32 | $3,617.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.19 / $3,212.00 / $5,421.20
| Professional | | $337.19 | $3,212.00 | $5,421.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.51 / $2,718.32 / $3,617.70
| Facility | | $366.51 | $2,718.32 | $3,617.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.94 / $2,446.40 / $3,210.83
| Professional | | $286.94 | $2,446.40 | $3,210.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,196.47 / $1,796.76 / $3,321.00
| Professional | | $1,196.47 | $1,796.76 | $3,321.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,230.86 / $2,230.86 / $4,246.80
| Professional | | $2,230.86 | $2,230.86 | $4,246.80 |