- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.14 / $1,464.95 / $7,975.21
| Professional | | $898.14 | $1,464.95 | $7,975.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,295.39 / $1,295.39 / $1,295.39
| Facility | | $1,295.39 | $1,295.39 | $1,295.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.63 / $945.63 / $1,295.39
| Professional | | $945.63 | $945.63 | $1,295.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,686.08 / $4,391.25 / $5,727.30
| Professional | | $1,686.08 | $4,391.25 | $5,727.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,464.95 / $2,006.98 / $2,408.67
| Facility | | $1,464.95 | $2,006.98 | $2,408.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,790.94 / $2,264.16 / $2,529.11
| Professional | | $1,790.94 | $2,264.16 | $2,529.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,911.95 / $2,271.46 / $2,498.62
| Facility | | $1,911.95 | $2,271.46 | $2,498.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,167.81 / $2,408.67 / $2,408.67
| Professional | | $2,167.81 | $2,408.67 | $2,408.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,295.39 / $2,068.71 / $2,529.11
| Facility | | $1,295.39 | $2,068.71 | $2,529.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.63 / $2,109.13 / $2,649.55
| Professional | | $945.63 | $2,109.13 | $2,649.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,006.78 / $4,005.54 / $8,450.44
| Facility | | $2,006.78 | $4,005.54 | $8,450.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,071.46 / $2,649.55 / $2,649.55
| Professional | | $2,071.46 | $2,649.55 | $2,649.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.14 / $1,034.25 / $1,973.21
| Professional | | $988.14 | $1,034.25 | $1,973.21 |