- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,179.47 / $5,600.26 / $7,439.15
| Professional | | $4,179.47 | $5,600.26 | $7,439.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.71 / $2,666.87 / $3,075.76
| Facility | | $793.71 | $2,666.87 | $3,075.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.64 / $601.82 / $601.82
| Professional | | $541.64 | $601.82 | $601.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,363.80 / $6,363.80 / $6,363.80
| Facility | | $6,363.80 | $6,363.80 | $6,363.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,969.00 / $3,969.00 / $6,208.63
| Facility | | $3,969.00 | $3,969.00 | $6,208.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,373.65 / $3,373.65 / $3,969.00
| Professional | | $3,373.65 | $3,373.65 | $3,969.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,408.42 / $6,408.42 / $6,408.42
| Facility | | $6,408.42 | $6,408.42 | $6,408.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,593.36 / $5,934.61 / $6,723.49
| Facility | | $3,593.36 | $5,934.61 | $6,723.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.20 / $2,578.23 / $7,471.00
| Professional | | $878.20 | $2,578.23 | $7,471.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,593.36 / $5,015.16 / $6,363.80
| Facility | | $3,593.36 | $5,015.16 | $6,363.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,578.23 / $3,373.65 / $5,325.66
| Professional | | $2,578.23 | $3,373.65 | $5,325.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.33 / $640.91 / $4,234.72
| Facility | | $337.33 | $640.91 | $4,234.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,248.84 / $2,935.32 / $4,390.20
| Professional | | $2,248.84 | $2,935.32 | $4,390.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,684.77 / $4,684.77 / $6,091.40
| Professional | | $4,684.77 | $4,684.77 | $6,091.40 |