- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,271.05 / $1,791.68 / $8,905.17
| Professional | | $1,271.05 | $1,791.68 | $8,905.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,373.71 / $2,373.71 / $2,373.71
| Facility | | $2,373.71 | $2,373.71 | $2,373.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,017.65 / $2,017.65 / $2,373.71
| Professional | | $2,017.65 | $2,017.65 | $2,373.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,062.12 / $5,657.58 / $7,378.89
| Professional | | $2,062.12 | $5,657.58 | $7,378.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,791.68 / $2,454.60 / $2,945.88
| Facility | | $1,791.68 | $2,454.60 | $2,945.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,178.35 / $2,324.53 / $2,945.88
| Professional | | $1,178.35 | $2,324.53 | $2,945.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,338.38 / $2,819.01 / $3,100.91
| Facility | | $2,338.38 | $2,819.01 | $3,100.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,340.23 / $2,945.88 / $2,945.88
| Professional | | $2,340.23 | $2,945.88 | $2,945.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,791.68 / $2,396.37 / $2,945.88
| Facility | | $1,791.68 | $2,396.37 | $2,945.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,017.65 / $2,579.52 / $3,240.47
| Professional | | $2,017.65 | $2,579.52 | $3,240.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.35 / $4,898.89 / $10,335.10
| Facility | | $2,454.35 | $4,898.89 | $10,335.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,533.46 / $3,240.47 / $3,240.47
| Professional | | $2,533.46 | $3,240.47 | $3,240.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,273.14 / $1,332.55 / $2,542.33
| Professional | | $1,273.14 | $1,332.55 | $2,542.33 |