- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $790.80 / $1,078.64 / $5,188.07
| Professional | | $790.80 | $1,078.64 | $5,188.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.38 / $1,028.38 / $1,028.38
| Facility | | $1,028.38 | $1,028.38 | $1,028.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.72 / $750.72 / $1,028.38
| Professional | | $750.72 | $750.72 | $1,028.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.69 / $3,485.74 / $4,546.29
| Professional | | $1,258.69 | $3,485.74 | $4,546.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.64 / $1,477.74 / $1,798.13
| Facility | | $1,078.64 | $1,477.74 | $1,798.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,336.98 / $1,690.24 / $1,888.04
| Professional | | $1,336.98 | $1,690.24 | $1,888.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,427.33 / $1,798.13 / $1,977.94
| Facility | | $1,427.33 | $1,798.13 | $1,977.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,618.32 / $1,798.13 / $1,862.51
| Professional | | $1,618.32 | $1,798.13 | $1,862.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.38 / $1,574.51 / $1,888.04
| Facility | | $1,028.38 | $1,574.51 | $1,888.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.72 / $1,574.51 / $1,977.94
| Professional | | $750.72 | $1,574.51 | $1,977.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,498.11 / $2,990.24 / $6,308.43
| Facility | | $1,498.11 | $2,990.24 | $6,308.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,546.39 / $1,977.94 / $1,977.94
| Professional | | $1,546.39 | $1,977.94 | $1,977.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $772.87 / $821.06 / $1,566.48
| Professional | | $772.87 | $821.06 | $1,566.48 |