- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,112.30 / $1,648.14 / $9,150.36
| Professional | | $1,112.30 | $1,648.14 | $9,150.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,486.28 / $1,486.28 / $1,486.28
| Facility | | $1,486.28 | $1,486.28 | $1,486.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.98 / $1,084.98 / $1,486.28
| Professional | | $1,084.98 | $1,084.98 | $1,486.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,896.91 / $5,038.28 / $6,571.17
| Professional | | $1,896.91 | $5,038.28 | $6,571.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,648.14 / $2,257.94 / $2,709.87
| Facility | | $1,648.14 | $2,257.94 | $2,709.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,014.89 / $2,547.28 / $2,845.36
| Professional | | $2,014.89 | $2,547.28 | $2,845.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,151.03 / $2,709.87 / $2,980.86
| Facility | | $2,151.03 | $2,709.87 | $2,980.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,438.88 / $2,709.87 / $2,812.59
| Professional | | $2,438.88 | $2,709.87 | $2,812.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,486.28 / $2,327.40 / $2,845.36
| Facility | | $1,486.28 | $2,327.40 | $2,845.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.98 / $2,372.86 / $2,980.86
| Professional | | $1,084.98 | $2,372.86 | $2,980.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,257.71 / $4,506.42 / $9,507.10
| Facility | | $2,257.71 | $4,506.42 | $9,507.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,330.48 / $2,980.86 / $2,980.86
| Professional | | $2,330.48 | $2,980.86 | $2,980.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.89 / $1,428.89 / $1,428.89
| Facility | | $1,428.89 | $1,428.89 | $1,428.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,116.99 / $1,186.65 / $2,263.96
| Professional | | $1,116.99 | $1,186.65 | $2,263.96 |