- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,493.28 / $6,020.75 / $7,997.72
| Professional | | $4,493.28 | $6,020.75 | $7,997.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,552.00 / $3,552.00 / $6,360.06
| Professional | | $3,552.00 | $3,552.00 | $6,360.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.30 / $2,867.09 / $3,306.72
| Facility | | $853.30 | $2,867.09 | $3,306.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.01 / $647.01 / $647.01
| Professional | | $647.01 | $647.01 | $647.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,847.89 / $4,397.59 / $4,672.43
| Professional | | $3,847.89 | $4,397.59 | $4,672.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,841.67 / $12,135.79 / $12,135.79
| Facility | | $6,841.67 | $12,135.79 | $12,135.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,960.08 / $4,978.93 / $6,674.80
| Facility | | $4,960.08 | $4,978.93 | $6,674.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,232.09 / $4,232.09 / $4,978.93
| Professional | | $4,232.09 | $4,232.09 | $4,978.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $6,889.88 / $6,889.88
| Facility | | $100.00 | $6,889.88 | $6,889.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,863.36 / $6,501.46 / $7,997.72
| Facility | | $3,863.36 | $6,501.46 | $7,997.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.15 / $4,891.62 / $10,346.60
| Professional | | $944.15 | $4,891.62 | $10,346.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,863.36 / $5,473.34 / $7,228.32
| Facility | | $3,863.36 | $5,473.34 | $7,228.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,771.92 / $4,232.09 / $5,725.78
| Professional | | $2,771.92 | $4,232.09 | $5,725.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,417.69 / $3,382.76 / $5,478.51
| Professional | | $2,417.69 | $3,382.76 | $5,478.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,549.24 / $8,456.90 / $8,456.90
| Professional | | $6,549.24 | $8,456.90 | $8,456.90 |