- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,606.28 / $5,742.22 / $10,242.03
| Professional | | $3,606.28 | $5,742.22 | $10,242.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $779.61 / $863.83 / $863.83
| Facility | | $779.61 | $863.83 | $863.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,092.92 / $7,275.60 / $15,845.02
| Professional | | $5,092.92 | $7,275.60 | $15,845.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,555.94 / $1,555.94 / $1,555.94
| Facility | | $1,555.94 | $1,555.94 | $1,555.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,072.81 / $8,072.81 / $8,547.89
| Facility | | $8,072.81 | $8,072.81 | $8,547.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,861.89 / $6,861.89 / $15,236.25
| Professional | | $6,861.89 | $6,861.89 | $15,236.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,730.71 / $8,730.71 / $10,476.86
| Professional | | $8,730.71 | $8,730.71 | $10,476.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.07 / $3,306.30 / $6,911.82
| Professional | | $638.07 | $3,306.30 | $6,911.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.00 / $8,823.10 / $8,823.10
| Facility | | $65.00 | $8,823.10 | $8,823.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,947.43 / $8,072.81 / $9,561.65
| Facility | | $4,947.43 | $8,072.81 | $9,561.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,667.92 / $8,072.81 / $8,072.81
| Professional | | $6,667.92 | $8,072.81 | $8,072.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,730.71 / $8,730.71 / $8,730.71
| Professional | | $8,730.71 | $8,730.71 | $8,730.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,435.20 / $3,715.40 / $5,373.00
| Professional | | $3,435.20 | $3,715.40 | $5,373.00 |