- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.64 / $1,209.20 / $1,703.10
| Professional | | $902.64 | $1,209.20 | $1,703.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,130.76 / $1,130.76 / $1,130.76
| Professional | | $1,130.76 | $1,130.76 | $1,130.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,863.65 / $5,812.27 / $6,951.41
| Facility | | $1,863.65 | $5,812.27 | $6,951.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.55 / $141.72 / $141.72
| Professional | | $127.55 | $141.72 | $141.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,780.40 / $1,780.40 / $1,780.40
| Facility | | $1,780.40 | $1,780.40 | $1,780.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,217.05 / $1,217.05 / $1,629.32
| Facility | | $1,217.05 | $1,217.05 | $1,629.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,034.49 / $1,034.49 / $1,597.37
| Professional | | $1,034.49 | $1,034.49 | $1,597.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,797.59 / $8,728.48 / $8,728.48
| Facility | | $2,797.59 | $8,728.48 | $8,728.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,294.35 / $1,507.46 / $1,851.99
| Facility | | $1,294.35 | $1,507.46 | $1,851.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.80 / $1,637.97 / $2,100.48
| Professional | | $163.80 | $1,637.97 | $2,100.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,217.05 / $1,417.27 / $1,780.40
| Facility | | $1,217.05 | $1,417.27 | $1,780.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,034.49 / $1,217.05 / $1,964.44
| Professional | | $1,034.49 | $1,217.05 | $1,964.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.76 / $1,080.96 / $1,731.55
| Professional | | $800.76 | $1,080.96 | $1,731.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,468.86 / $1,468.86 / $1,468.86
| Professional | | $1,468.86 | $1,468.86 | $1,468.86 |