- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $937.63 / $1,138.03 / $1,641.69
| Professional | | $937.63 | $1,138.03 | $1,641.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.21 / $116.21 / $116.21
| Professional | | $116.21 | $116.21 | $116.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.29 / $150.00 / $150.00
| Professional | | $86.29 | $150.00 | $150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,106.60 / $2,106.60 / $2,106.60
| Facility | | $2,106.60 | $2,106.60 | $2,106.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.70 / $396.70 / $396.70
| Facility | | $396.70 | $396.70 | $396.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.33 / $396.70 / $396.70
| Professional | | $156.33 | $396.70 | $396.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,431.46 / $9,451.79 / $9,796.40
| Facility | | $3,431.46 | $9,451.79 | $9,796.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.61 / $576.67 / $1,562.83
| Facility | | $118.61 | $576.67 | $1,562.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.88 / $193.81 / $1,762.93
| Professional | | $164.88 | $193.81 | $1,762.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.19 / $576.67 / $1,401.90
| Facility | | $152.19 | $576.67 | $1,401.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.88 / $396.70 / $396.70
| Professional | | $148.88 | $396.70 | $396.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $649.57 / $768.16 / $1,180.34
| Professional | | $649.57 | $768.16 | $1,180.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,143.60 / $1,143.60 / $1,270.04
| Professional | | $1,143.60 | $1,143.60 | $1,270.04 |