- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,196.29 / $1,821.91 / $3,017.85
| Professional | | $1,196.29 | $1,821.91 | $3,017.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,315.98 / $2,315.98 / $2,894.98
| Professional | | $2,315.98 | $2,315.98 | $2,894.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.02 / $261.02 / $3,393.26
| Facility | | $261.02 | $261.02 | $3,393.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.02 / $261.02 / $3,393.26
| Professional | | $261.02 | $261.02 | $3,393.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.09 / $1,850.09 / $1,850.09
| Facility | | $1,850.09 | $1,850.09 | $1,850.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.95 / $1,572.58 / $3,648.75
| Professional | | $271.95 | $1,572.58 | $3,648.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,908.37 / $2,385.46 / $2,385.46
| Professional | | $1,908.37 | $2,385.46 | $2,385.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,131.69 / $2,264.92 / $2,385.46
| Professional | | $2,131.69 | $2,264.92 | $2,385.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.09 / $1,850.09 / $1,850.09
| Facility | | $1,850.09 | $1,850.09 | $1,850.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.95 / $1,572.58 / $3,648.75
| Professional | | $271.95 | $1,572.58 | $3,648.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,949.85 / $3,264.96
| Professional | | $1,047.13 | $1,949.85 | $3,264.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,131.69 / $2,131.69 / $2,131.69
| Facility | | $2,131.69 | $2,131.69 | $2,131.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,131.69 / $2,131.69 / $2,385.46
| Professional | | $2,131.69 | $2,131.69 | $2,385.46 |