- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,707.93 / $7,060.69 / $9,943.08
| Professional | | $4,707.93 | $7,060.69 | $9,943.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.50 / $875.90 / $875.90
| Facility | | $790.50 | $875.90 | $875.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,647.70 / $8,548.46 / $10,897.53
| Professional | | $6,647.70 | $8,548.46 | $10,897.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,031.24 / $2,031.24 / $2,031.24
| Facility | | $2,031.24 | $2,031.24 | $2,031.24 |
- 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
- $8,318.62 / $8,391.94 / $8,391.94
| Facility | | $8,318.62 | $8,391.94 | $8,391.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,133.15 / $7,133.15 / $16,584.38
| Professional | | $7,133.15 | $7,133.15 | $16,584.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,397.96 / $11,397.96 / $13,677.55
| Professional | | $11,397.96 | $11,397.96 | $13,677.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.07 / $7,474.28 / $9,023.39
| Professional | | $638.07 | $7,474.28 | $9,023.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.00 / $11,518.64 / $11,518.64
| Facility | | $65.00 | $11,518.64 | $11,518.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,458.88 / $7,630.07 / $9,738.87
| Facility | | $6,458.88 | $7,630.07 | $9,738.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,133.15 / $7,133.15 / $8,391.94
| Professional | | $7,133.15 | $7,133.15 | $8,391.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,397.96 / $11,397.96 / $11,397.96
| Professional | | $11,397.96 | $11,397.96 | $11,397.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,224.28 / $4,453.60 / $7,509.22
| Professional | | $4,224.28 | $4,453.60 | $7,509.22 |