- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,565.95 / $7,458.11 / $9,907.04
| Professional | | $5,565.95 | $7,458.11 | $9,907.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,018.28 / $7,018.28 / $7,018.28
| Professional | | $7,018.28 | $7,018.28 | $7,018.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,057.02 / $3,551.59 / $4,096.16
| Facility | | $1,057.02 | $3,551.59 | $4,096.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.32 / $801.47 / $801.47
| Professional | | $721.32 | $801.47 | $801.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,804.14 / $5,490.46 / $5,833.61
| Professional | | $4,804.14 | $5,490.46 | $5,833.61 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $5,300.15 / $5,300.15 / $8,268.27
| Facility | | $5,300.15 | $5,300.15 | $8,268.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,505.13 / $5,300.15 / $6,350.40
| Professional | | $4,505.13 | $5,300.15 | $6,350.40 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $4,785.60 / $7,903.37 / $8,953.93
| Facility | | $4,785.60 | $7,903.37 | $8,953.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,169.54 / $1,271.24 / $9,949.79
| Professional | | $1,169.54 | $1,271.24 | $9,949.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,785.60 / $6,678.90 / $8,474.94
| Facility | | $4,785.60 | $6,678.90 | $8,474.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.47 / $5,300.15 / $5,459.15
| Professional | | $898.47 | $5,300.15 | $5,459.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,994.90 / $3,909.24 / $5,846.80
| Professional | | $2,994.90 | $3,909.24 | $5,846.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,112.40 / $9,358.74 / $9,358.74
| Professional | | $8,112.40 | $9,358.74 | $9,358.74 |