- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,800.58 / $2,406.10 / $3,381.09
| Professional | | $1,800.58 | $2,406.10 | $3,381.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.24 / $1,195.02 / $1,358.62
| Facility | | $364.24 | $1,195.02 | $1,358.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.09 / $243.09 / $243.09
| Professional | | $243.09 | $243.09 | $243.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,120.89 / $4,120.89 / $4,120.89
| Facility | | $4,120.89 | $4,120.89 | $4,120.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,399.94 / $2,399.94 / $4,012.16
| Facility | | $2,399.94 | $2,399.94 | $4,012.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,039.95 / $2,399.94 / $2,471.94
| Professional | | $2,039.95 | $2,399.94 | $2,471.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,897.50 / $21,753.30 / $22,546.40
| Facility | | $7,897.50 | $21,753.30 | $22,546.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,308.95 / $2,896.58 / $4,120.89
| Facility | | $1,308.95 | $2,896.58 | $4,120.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.12 / $1,113.04 / $3,742.21
| Professional | | $379.12 | $1,113.04 | $3,742.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,308.95 / $2,489.01 / $4,120.89
| Facility | | $1,308.95 | $2,489.01 | $4,120.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.16 / $2,399.94 / $2,399.94
| Professional | | $326.16 | $2,399.94 | $2,399.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,678.14 / $2,080.50 / $2,908.78
| Professional | | $1,678.14 | $2,080.50 | $2,908.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,629.82 / $3,033.82 / $3,033.82
| Professional | | $2,629.82 | $3,033.82 | $3,033.82 |