- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,983.53 / $7,935.18 / $14,153.49
| Professional | | $4,983.53 | $7,935.18 | $14,153.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,077.33 / $1,193.73 / $1,193.73
| Facility | | $1,077.33 | $1,193.73 | $1,193.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,037.87 / $10,606.94 / $21,896.30
| Professional | | $7,037.87 | $10,606.94 | $21,896.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,150.15 / $2,150.15 / $2,150.15
| Facility | | $2,150.15 | $2,150.15 | $2,150.15 |
- 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
- $11,155.72 / $11,155.72 / $11,812.31
| Facility | | $11,155.72 | $11,155.72 | $11,812.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,482.36 / $9,482.36 / $21,056.25
| Professional | | $9,482.36 | $9,482.36 | $21,056.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,064.92 / $12,064.92 / $14,477.90
| Professional | | $12,064.92 | $12,064.92 | $14,477.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.07 / $8,377.20 / $9,551.39
| Professional | | $638.07 | $8,377.20 | $9,551.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.00 / $12,192.66 / $12,192.66
| Facility | | $65.00 | $12,192.66 | $12,192.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,836.80 / $11,155.72 / $13,213.29
| Facility | | $6,836.80 | $11,155.72 | $13,213.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,996.40 / $11,155.72 / $11,155.72
| Professional | | $8,996.40 | $11,155.72 | $11,155.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,064.92 / $12,064.92 / $12,064.92
| Professional | | $12,064.92 | $12,064.92 | $12,064.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,747.08 / $5,134.32 / $7,300.58
| Professional | | $4,747.08 | $5,134.32 | $7,300.58 |