- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,107.57 / $4,391.01 / $6,505.46
| Professional | | $3,107.57 | $4,391.01 | $6,505.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.78 / $578.15 / $578.15
| Facility | | $521.78 | $578.15 | $578.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,388.00 / $5,642.37 / $7,193.22
| Professional | | $4,388.00 | $5,642.37 | $7,193.22 |
- 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
- $5,442.61 / $5,470.13 / $5,470.13
| Facility | | $5,442.61 | $5,470.13 | $5,470.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,649.60 / $5,470.13 / $8,643.75
| Professional | | $4,649.60 | $5,470.13 | $8,643.75 |
- 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 / $5,955.84
| Professional | | $638.07 | $4,933.57 | $5,955.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.00 / $7,602.76 / $7,602.76
| Facility | | $65.00 | $7,602.76 | $7,602.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,263.12 / $4,969.67 / $6,376.65
| Facility | | $4,263.12 | $4,969.67 | $6,376.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,649.60 / $5,470.13 / $5,578.68
| Professional | | $4,649.60 | $5,470.13 | $5,578.68 |
- 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
- $2,511.40 / $2,763.88 / $4,639.28
| Professional | | $2,511.40 | $2,763.88 | $4,639.28 |