- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,527.54 / $2,969.85 / $2,969.85
| Professional | | $2,527.54 | $2,969.85 | $2,969.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,239.60 / $1,239.60 / $13,072.13
| Professional | | $1,239.60 | $1,239.60 | $13,072.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,807.25 / $4,807.25 / $4,807.25
| Facility | | $4,807.25 | $4,807.25 | $4,807.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,694.91 / $10,160.69 / $15,586.75
| Facility | | $8,694.91 | $10,160.69 | $15,586.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,739.18 / $8,507.69 / $9,667.83
| Professional | | $3,739.18 | $8,507.69 | $9,667.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,432.75 / $3,791.30 / $11,057.97
| Facility | | $2,432.75 | $3,791.30 | $11,057.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,432.75 / $3,791.30 / $11,057.97
| Facility | | $2,432.75 | $3,791.30 | $11,057.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,579.71 / $1,895.65 / $9,743.18
| Professional | | $1,579.71 | $1,895.65 | $9,743.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $58.40 / $70.00
| Professional | | $50.00 | $58.40 | $70.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,432.75 / $3,791.30 / $11,057.97
| Facility | | $2,432.75 | $3,791.30 | $11,057.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,274.18 / $7,533.29 / $10,565.94
| Professional | | $5,274.18 | $7,533.29 | $10,565.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,318.84 / $15,007.25 / $15,007.25
| Facility | | $6,318.84 | $15,007.25 | $15,007.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,637.68 / $12,637.68 / $15,733.91
| Professional | | $12,637.68 | $12,637.68 | $15,733.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,728.12 / $6,728.12 / $6,728.12
| Professional | | $6,728.12 | $6,728.12 | $6,728.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,250.43 / $17,250.43 / $17,250.43
| Professional | | $17,250.43 | $17,250.43 | $17,250.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,159.42 / $3,159.42 / $3,159.42
| Facility | | $3,159.42 | $3,159.42 | $3,159.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,373.40 / $1,895.65 / $6,634.78
| Professional | | $1,373.40 | $1,895.65 | $6,634.78 |