- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,288.25 / $2,089.30
| Professional | | $912.01 | $1,288.25 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,238.72 / $3,467.37
| Facility | | $1,698.24 | $2,238.72 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,630.27 / $2,630.27
| Professional | | $2,511.89 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,513.56
| Facility | | $1,174.90 | $1,174.90 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $1,174.90
| Professional | | $870.96 | $870.96 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,862.09 / $2,398.83
| Facility | | $575.44 | $1,862.09 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,290.87 / $2,398.83
| Professional | | $1,584.89 | $2,290.87 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $2,041.74
| Professional | | $30.20 | $30.20 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,290.87 / $2,290.87
| Facility | | $2,238.72 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $2,630.27
| Professional | | $1,698.24 | $1,698.24 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,398.83 / $2,398.83
| Professional | | $1,862.09 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,047.13 / $1,202.26
| Facility | | $891.25 | $1,047.13 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $891.25 / $1,258.93
| Professional | | $831.76 | $891.25 | $1,258.93 |