- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.43 / $1,074.69 / $1,459.78
| Professional | | $954.43 | $1,074.69 | $1,459.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.46 / $1,487.10 / $1,784.63
| Professional | | $178.46 | $1,487.10 | $1,784.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,217.05 / $1,217.05 / $1,674.92
| Facility | | $1,217.05 | $1,217.05 | $1,674.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,034.49 / $1,034.49 / $2,685.94
| Professional | | $1,034.49 | $1,034.49 | $2,685.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,641.86 / $1,641.86 / $1,784.63
| Professional | | $1,641.86 | $1,641.86 | $1,784.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,495.43 / $1,495.43 / $1,495.43
| Professional | | $1,495.43 | $1,495.43 | $1,495.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.43 / $1,074.69 / $2,338.48
| Professional | | $954.43 | $1,074.69 | $2,338.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,217.05 / $1,217.05 / $1,674.92
| Facility | | $1,217.05 | $1,217.05 | $1,674.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,034.49 / $1,455.57 / $2,685.94
| Professional | | $1,034.49 | $1,455.57 | $2,685.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,794.48 / $1,858.88 / $1,873.47
| Professional | | $1,794.48 | $1,858.88 | $1,873.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.65 / $1,118.19 / $2,255.33
| Professional | | $801.65 | $1,118.19 | $2,255.33 |