- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $963.34 / $1,303.19 / $1,784.36
| Professional | | $963.34 | $1,303.19 | $1,784.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,985.28 / $1,985.28 / $1,985.28
| Professional | | $1,985.28 | $1,985.28 | $1,985.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.31 / $126.31 / $126.31
| Professional | | $126.31 | $126.31 | $126.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,655.20 / $1,891.66 / $2,009.88
| Professional | | $1,655.20 | $1,891.66 | $2,009.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,289.69 / $2,289.69 / $2,289.69
| Facility | | $2,289.69 | $2,289.69 | $2,289.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,082.51 / $1,082.51 / $2,233.78
| Facility | | $1,082.51 | $1,082.51 | $2,233.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.91 / $1,082.51 / $1,114.99
| Professional | | $169.91 | $1,082.51 | $1,114.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,729.63 / $10,273.09 / $10,647.60
| Facility | | $3,729.63 | $10,273.09 | $10,647.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.97 / $1,114.33 / $1,718.95
| Facility | | $228.97 | $1,114.33 | $1,718.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.51 / $618.44 / $1,916.13
| Professional | | $194.51 | $618.44 | $1,916.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.97 / $1,082.51 / $1,638.73
| Facility | | $228.97 | $1,082.51 | $1,638.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.82 / $1,082.51 / $1,082.51
| Professional | | $161.82 | $1,082.51 | $1,082.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $803.00 / $962.24 / $1,392.92
| Professional | | $803.00 | $962.24 | $1,392.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,457.01 / $1,685.57 / $1,685.57
| Professional | | $1,457.01 | $1,685.57 | $1,685.57 |