- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,492.85 / $2,034.50 / $9,651.53
| Professional | | $1,492.85 | $2,034.50 | $9,651.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,217.07 / $2,217.07 / $2,217.07
| Facility | | $2,217.07 | $2,217.07 | $2,217.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,618.46 / $1,618.46 / $2,217.07
| Professional | | $1,618.46 | $1,618.46 | $2,217.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,341.59 / $6,484.98 / $8,458.04
| Professional | | $2,341.59 | $6,484.98 | $8,458.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,034.50 / $2,787.27 / $3,345.13
| Facility | | $2,034.50 | $2,787.27 | $3,345.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,487.23 / $3,144.42 / $3,512.39
| Professional | | $2,487.23 | $3,144.42 | $3,512.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,655.29 / $3,345.13 / $3,679.64
| Facility | | $2,655.29 | $3,345.13 | $3,679.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,010.62 / $3,345.13 / $3,512.39
| Professional | | $3,010.62 | $3,345.13 | $3,512.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,034.50 / $2,873.02 / $3,512.39
| Facility | | $2,034.50 | $2,873.02 | $3,512.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,618.46 / $2,929.12 / $3,679.64
| Professional | | $1,618.46 | $2,929.12 | $3,679.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,786.98 / $5,562.84 / $11,735.81
| Facility | | $2,786.98 | $5,562.84 | $11,735.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,876.81 / $3,679.64 / $3,679.64
| Professional | | $2,876.81 | $3,679.64 | $3,679.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,018.42 / $2,018.42 / $2,071.29
| Facility | | $2,018.42 | $2,018.42 | $2,071.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,459.34 / $1,527.44 / $2,989.92
| Professional | | $1,459.34 | $1,527.44 | $2,989.92 |