- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,769.92 / $2,412.10 / $11,442.80
| Professional | | $1,769.92 | $2,412.10 | $11,442.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,282.71 / $2,282.71 / $2,282.71
| Facility | | $2,282.71 | $2,282.71 | $2,282.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,666.39 / $1,666.39 / $2,282.71
| Professional | | $1,666.39 | $1,666.39 | $2,282.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,776.19 / $7,737.79 / $10,092.03
| Professional | | $2,776.19 | $7,737.79 | $10,092.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.10 / $3,304.58 / $3,965.99
| Facility | | $2,412.10 | $3,304.58 | $3,965.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,948.86 / $3,728.03 / $4,164.29
| Professional | | $2,948.86 | $3,728.03 | $4,164.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,148.11 / $3,965.99 / $4,362.59
| Facility | | $3,148.11 | $3,965.99 | $4,362.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,150.62 / $3,965.99 / $4,164.29
| Professional | | $3,150.62 | $3,965.99 | $4,164.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,282.71 / $3,406.24 / $4,164.29
| Facility | | $2,282.71 | $3,406.24 | $4,164.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,666.39 / $3,472.76 / $4,362.59
| Professional | | $1,666.39 | $3,472.76 | $4,362.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,304.24 / $6,595.28 / $13,913.96
| Facility | | $3,304.24 | $6,595.28 | $13,913.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,410.75 / $4,362.59 / $4,362.59
| Professional | | $3,410.75 | $4,362.59 | $4,362.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,982.23 / $1,982.23 / $1,982.23
| Facility | | $1,982.23 | $1,982.23 | $1,982.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,741.28 / $1,822.54 / $3,493.19
| Professional | | $1,741.28 | $1,822.54 | $3,493.19 |