- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $6,918.31 / $6,918.31
| Facility | | $3,019.95 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,041.74 / $3,019.95
| Professional | | $1,659.59 | $2,041.74 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $302.00 / $8,912.51
| Professional | | $257.04 | $302.00 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,128.31 / $12,882.50
| Facility | | $6,918.31 | $8,128.31 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,311.31 / $7,762.47
| Professional | | $2,630.27 | $3,311.31 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $10,471.29 / $15,848.93
| Facility | | $2,754.23 | $10,471.29 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,135.61 / $15,135.61 / $16,595.87
| Professional | | $15,135.61 | $15,135.61 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,019.95 / $8,709.64
| Facility | | $2,238.72 | $3,019.95 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,513.56 / $12,589.25
| Professional | | $1,122.02 | $1,513.56 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $70.79 / $2,511.89
| Professional | | $50.12 | $70.79 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,888.44 / $8,317.64
| Professional | | $4,073.80 | $5,888.44 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $12,022.64 / $12,022.64
| Facility | | $5,011.87 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,000.00 / $12,589.25
| Professional | | $3,630.78 | $10,000.00 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $5,370.32
| Professional | | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,803.84 / $13,803.84 / $13,803.84
| Professional | | $13,803.84 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $3,019.95
| Facility | | $1,995.26 | $1,995.26 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $4,168.69
| Professional | | $1,047.13 | $1,513.56 | $4,168.69 |