- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,488.33 / $5,554.45 / $9,907.04
| Professional | | $3,488.33 | $5,554.45 | $9,907.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $754.11 / $835.58 / $835.58
| Facility | | $754.11 | $835.58 | $835.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,926.32 / $7,037.60 / $15,326.79
| Professional | | $4,926.32 | $7,037.60 | $15,326.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,505.06 / $1,505.06 / $1,505.06
| Facility | | $1,505.06 | $1,505.06 | $1,505.06 |
- 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
- $4,978.93 / $4,978.93 / $4,978.93
| Facility | | $4,978.93 | $4,978.93 | $4,978.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,232.09 / $4,978.93 / $14,737.50
| Professional | | $4,232.09 | $4,978.93 | $14,737.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,445.12 / $8,445.12 / $10,134.14
| Professional | | $8,445.12 | $8,445.12 | $10,134.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.07 / $5,863.86 / $6,685.72
| Professional | | $638.07 | $5,863.86 | $6,685.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.00 / $8,534.45 / $8,534.45
| Facility | | $65.00 | $8,534.45 | $8,534.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,785.60 / $7,458.11 / $8,905.20
| Facility | | $4,785.60 | $7,458.11 | $8,905.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,232.09 / $4,978.93 / $5,330.00
| Professional | | $4,232.09 | $4,978.93 | $5,330.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,445.12 / $8,445.12 / $8,445.12
| Professional | | $8,445.12 | $8,445.12 | $8,445.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,116.79 / $3,593.88 / $7,203.96
| Professional | | $3,116.79 | $3,593.88 | $7,203.96 |