- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,259.18 / $5,384.25 / $7,152.22
| Professional | | $4,259.18 | $5,384.25 | $7,152.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.09 / $2,563.98 / $2,957.12
| Facility | | $763.09 | $2,563.98 | $2,957.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.75 / $578.61 / $578.61
| Professional | | $520.75 | $578.61 | $578.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,118.33 / $6,118.33 / $6,118.33
| Facility | | $6,118.33 | $6,118.33 | $6,118.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,087.00 / $3,087.00 / $5,969.12
| Facility | | $3,087.00 | $3,087.00 | $5,969.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,623.95 / $3,087.00 / $3,790.53
| Professional | | $2,623.95 | $3,087.00 | $3,790.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,161.32 / $6,161.32 / $6,161.32
| Facility | | $6,161.32 | $6,161.32 | $6,161.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,454.88 / $5,705.70 / $6,464.12
| Facility | | $3,454.88 | $5,705.70 | $6,464.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $844.33 / $917.75 / $7,183.10
| Professional | | $844.33 | $917.75 | $7,183.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,087.00 / $4,821.72 / $6,118.34
| Facility | | $3,087.00 | $4,821.72 | $6,118.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.63 / $3,087.00 / $3,790.53
| Professional | | $648.63 | $3,087.00 | $3,790.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,162.10 / $2,822.24 / $4,220.96
| Professional | | $2,162.10 | $2,822.24 | $4,220.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,504.27 / $4,504.27 / $6,045.20
| Professional | | $4,504.27 | $4,504.27 | $6,045.20 |