- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $817.20 / $849.25 / $2,212.85
| Facility | | $817.20 | $849.25 | $2,212.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.28 / $849.25 / $1,201.76
| Professional | | $679.28 | $849.25 | $1,201.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,089.59 / $1,089.59 / $1,089.59
| Professional | | $1,089.59 | $1,089.59 | $1,089.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,829.93 / $1,829.93 / $1,829.93
| Facility | | $1,829.93 | $1,829.93 | $1,829.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.19 / $969.19 / $969.19
| Facility | | $969.19 | $969.19 | $969.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.51 / $707.51 / $707.51
| Professional | | $707.51 | $707.51 | $707.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,786.07 / $7,319.72 / $7,319.72
| Facility | | $2,786.07 | $7,319.72 | $7,319.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,113.04 / $9,113.04 / $10,293.37
| Professional | | $9,113.04 | $9,113.04 | $10,293.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.03 / $1,344.98 / $1,829.93
| Facility | | $442.03 | $1,344.98 | $1,829.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.03 / $1,547.48 / $1,829.93
| Professional | | $442.03 | $1,547.48 | $1,829.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.03 / $1,100.17 / $1,829.93
| Facility | | $442.03 | $1,100.17 | $1,829.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.51 / $707.51 / $1,201.76
| Professional | | $707.51 | $707.51 | $1,201.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.59 / $825.13 / $1,040.63
| Professional | | $570.59 | $825.13 | $1,040.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.05 / $822.24 / $1,829.93
| Professional | | $816.05 | $822.24 | $1,829.93 |