- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,747.95 / $2,184.48 / $3,551.76
| Professional | | $1,747.95 | $2,184.48 | $3,551.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $4,847.72 / $4,847.72
| Facility | | $100.00 | $4,847.72 | $4,847.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,676.92 / $2,823.41 / $5,026.41
| Professional | | $1,676.92 | $2,823.41 | $5,026.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,446.40 / $2,446.40 / $2,446.40
| Facility | | $2,446.40 | $2,446.40 | $2,446.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.08 / $2,235.60 / $3,331.31
| Professional | | $321.08 | $2,235.60 | $3,331.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,317.13 / $2,317.13 / $2,317.13
| Facility | | $2,317.13 | $2,317.13 | $2,317.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,317.13 / $2,317.13 / $2,317.13
| Professional | | $2,317.13 | $2,317.13 | $2,317.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79,999.20 / $79,999.20 / $79,999.20
| Facility | | $79,999.20 | $79,999.20 | $79,999.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.29 / $383.29 / $383.29
| Facility | | $383.29 | $383.29 | $383.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,868.24 / $2,868.24 / $3,880.56
| Professional | | $2,868.24 | $2,868.24 | $3,880.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.60 / $487.60 / $593.70
| Professional | | $487.60 | $487.60 | $593.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,435.76 / $1,845.00 / $2,756.07
| Professional | | $1,435.76 | $1,845.00 | $2,756.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,969.78 / $3,969.78 / $3,969.78
| Professional | | $3,969.78 | $3,969.78 | $3,969.78 |