- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,107.57 / $4,948.24 / $7,017.12
| Professional | | $3,107.57 | $4,948.24 | $7,017.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.91 / $399.90 / $399.90
| Facility | | $360.91 | $399.90 | $399.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,999.00 / $5,642.37 / $8,679.23
| Professional | | $3,999.00 | $5,642.37 | $8,679.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,340.77 / $1,340.77 / $1,340.77
| Facility | | $1,340.77 | $1,340.77 | $1,340.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,135.65 / $6,410.99 / $6,410.99
| Facility | | $6,135.65 | $6,410.99 | $6,410.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,449.34 / $5,449.34 / $10,770.00
| Professional | | $5,449.34 | $5,449.34 | $10,770.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,523.16 / $7,523.16 / $9,027.79
| Professional | | $7,523.16 | $7,523.16 | $9,027.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.07 / $4,933.57 / $5,955.83
| Professional | | $638.07 | $4,933.57 | $5,955.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $42,593.27 / $44,146.17
| Facility | | $100.00 | $42,593.27 | $44,146.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.45 / $4,832.05 / $10,797.77
| Facility | | $882.45 | $4,832.05 | $10,797.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,568.39 / $6,410.99 / $6,410.99
| Professional | | $4,568.39 | $6,410.99 | $6,410.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,523.16 / $7,523.16 / $7,523.16
| Professional | | $7,523.16 | $7,523.16 | $7,523.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,844.44 / $2,960.16 / $5,309.21
| Professional | | $2,844.44 | $2,960.16 | $5,309.21 |