- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,760.83 / $8,709.64
| Professional | | $4,897.79 | $6,760.83 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,235.94 / $3,548.13
| Facility | | $2,290.87 | $3,235.94 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $691.83 / $691.83
| Professional | | $616.60 | $691.83 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,585.78
| Facility | | $7,413.10 | $7,413.10 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $5,370.32
| Facility | | $3,715.35 | $3,715.35 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,715.35 / $6,025.60
| Professional | | $3,162.28 | $3,715.35 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $7,413.10 / $7,413.10
| Facility | | $100.00 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,754.40 / $7,585.78
| Facility | | $1,071.52 | $5,754.40 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $8,709.64 / $8,709.64
| Professional | | $5,128.61 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $1,023.29 / $6,025.60
| Professional | | $302.00 | $1,023.29 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,025.60 / $7,585.78
| Facility | | $3,715.35 | $6,025.60 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,162.28 / $6,025.60
| Professional | | $3,019.95 | $3,162.28 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $741.31 / $4,677.35
| Facility | | $354.81 | $741.31 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,311.31 / $5,623.41
| Professional | | $2,454.71 | $3,311.31 | $5,623.41 |