- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,129.15 / $2,440.98 / $8,357.09
| Professional | | $1,129.15 | $2,440.98 | $8,357.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.58 / $1,017.04 / $1,157.06
| Professional | | $924.58 | $1,017.04 | $1,157.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,146.44 / $1,929.08 / $3,872.91
| Professional | | $1,146.44 | $1,929.08 | $3,872.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,218.53 / $1,773.76 / $4,080.32
| Professional | | $1,218.53 | $1,773.76 | $4,080.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,109.83 / $7,224.84 / $9,162.59
| Professional | | $2,109.83 | $7,224.84 | $9,162.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $958.06 / $1,338.65 / $1,807.18
| Professional | | $958.06 | $1,338.65 | $1,807.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.61 / $1,327.84 / $2,512.21
| Professional | | $1,006.61 | $1,327.84 | $2,512.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,883.41 / $9,149.92 / $9,149.92
| Professional | | $8,883.41 | $9,149.92 | $9,149.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,035.91 / $2,270.32 / $7,224.84
| Professional | | $1,035.91 | $2,270.32 | $7,224.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,088.78 / $4,088.78 / $4,088.78
| Professional | | $4,088.78 | $4,088.78 | $4,088.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,082.78 / $1,341.28 / $1,628.70
| Professional | | $1,082.78 | $1,341.28 | $1,628.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,143.25 / $1,553.39 / $4,116.71
| Professional | | $1,143.25 | $1,553.39 | $4,116.71 |