- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.77 / $1,236.68 / $2,048.53
| Professional | | $808.77 | $1,236.68 | $2,048.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,565.74 / $1,565.74 / $1,957.18
| Professional | | $1,565.74 | $1,565.74 | $1,957.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.19 / $177.19 / $2,303.46
| Facility | | $177.19 | $177.19 | $2,303.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.19 / $177.19 / $2,303.46
| Professional | | $177.19 | $177.19 | $2,303.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,361.88 / $1,361.88 / $1,361.88
| Facility | | $1,361.88 | $1,361.88 | $1,361.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.88 / $1,743.98 / $2,463.75
| Professional | | $169.88 | $1,743.98 | $2,463.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,290.18 / $1,612.72 / $1,612.72
| Professional | | $1,290.18 | $1,612.72 | $1,612.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,441.16 / $1,531.23 / $1,612.72
| Professional | | $1,441.16 | $1,531.23 | $1,612.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,361.88 / $1,361.88 / $1,361.88
| Facility | | $1,361.88 | $1,361.88 | $1,361.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.88 / $1,361.80 / $2,463.75
| Professional | | $169.88 | $1,361.80 | $2,463.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.35 / $1,235.35 / $1,763.00
| Professional | | $787.35 | $1,235.35 | $1,763.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,441.16 / $1,441.16 / $1,441.16
| Facility | | $1,441.16 | $1,441.16 | $1,441.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,441.16 / $1,441.16 / $1,612.72
| Professional | | $1,441.16 | $1,441.16 | $1,612.72 |