- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,513.56 / $2,238.72
| Professional | | $1,023.29 | $1,513.56 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,398.83 / $4,073.80
| Facility | | $1,995.26 | $2,398.83 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,818.38 / $2,818.38
| Professional | | $2,630.27 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,737.80 / $1,737.80
| Facility | | $1,445.44 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $1,737.80
| Professional | | $1,288.25 | $1,288.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,089.30 / $2,754.23
| Facility | | $724.44 | $2,089.30 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,398.83 / $2,570.40
| Professional | | $1,995.26 | $2,398.83 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $2,137.96
| Professional | | $30.20 | $30.20 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,454.71 / $2,454.71
| Facility | | $2,398.83 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,819.70 / $2,818.38
| Professional | | $1,778.28 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,570.40 / $2,630.27
| Professional | | $1,995.26 | $2,570.40 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,479.11 / $1,698.24
| Facility | | $977.24 | $1,479.11 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,122.02 / $1,737.80
| Professional | | $1,047.13 | $1,122.02 | $1,737.80 |