- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,354.78 / $6,356.20 / $10,018.35
| Professional | | $6,354.78 | $6,356.20 | $10,018.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $8,534.45 / $8,534.45
| Facility | | $100.00 | $8,534.45 | $8,534.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,960.00 / $6,705.73 / $12,414.50
| Professional | | $4,960.00 | $6,705.73 | $12,414.50 |
- 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 / $5,609.52
| Professional | | $4,232.09 | $4,978.93 | $5,609.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,474.93 / $8,474.93 / $8,474.93
| Facility | | $8,474.93 | $8,474.93 | $8,474.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,474.93 / $8,474.93 / $8,474.93
| Professional | | $8,474.93 | $8,474.93 | $8,474.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,285.53 / $7,448.69 / $9,103.96
| Professional | | $6,285.53 | $7,448.69 | $9,103.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,166.94 / $7,166.94 / $7,166.94
| Facility | | $7,166.94 | $7,166.94 | $7,166.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,166.94 / $7,166.94 / $7,166.94
| Professional | | $7,166.94 | $7,166.94 | $7,166.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,113.15 / $1,113.15 / $1,113.15
| Facility | | $1,113.15 | $1,113.15 | $1,113.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,552.33 / $12,414.50 / $22,384.82
| Professional | | $10,552.33 | $12,414.50 | $22,384.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.42 / $858.42 / $1,045.21
| Professional | | $858.42 | $858.42 | $1,045.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,322.84 / $3,593.88 / $6,856.60
| Professional | | $3,322.84 | $3,593.88 | $6,856.60 |