- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,486.06 / $6,011.11 / $7,984.90
| Professional | | $4,486.06 | $6,011.11 | $7,984.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.94 / $2,862.52 / $3,301.44
| Facility | | $851.94 | $2,862.52 | $3,301.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.62 / $645.97 / $645.97
| Professional | | $487.62 | $645.97 | $645.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,830.67 / $6,830.67 / $6,830.67
| Facility | | $6,830.67 | $6,830.67 | $6,830.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,321.80 / $4,321.80 / $6,664.07
| Facility | | $4,321.80 | $4,321.80 | $6,664.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,673.53 / $3,673.53 / $4,321.80
| Professional | | $3,673.53 | $3,673.53 | $4,321.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,878.76 / $6,878.76 / $6,878.76
| Facility | | $6,878.76 | $6,878.76 | $6,878.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,857.20 / $6,369.98 / $7,216.70
| Facility | | $3,857.20 | $6,369.98 | $7,216.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $942.63 / $2,767.48 / $8,019.40
| Professional | | $942.63 | $2,767.48 | $8,019.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,857.20 / $5,383.08 / $6,830.67
| Facility | | $3,857.20 | $5,383.08 | $6,830.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,767.48 / $3,673.53 / $5,716.54
| Professional | | $2,767.48 | $3,673.53 | $5,716.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,413.84 / $3,150.80 / $5,283.24
| Professional | | $2,413.84 | $3,150.80 | $5,283.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,028.67 / $5,028.67 / $6,538.50
| Professional | | $5,028.67 | $5,028.67 | $6,538.50 |