- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $8,317.64
| Facility | | $8,317.64 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,398.83 / $2,951.21
| Professional | | $1,819.70 | $2,398.83 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,513.56 / $11,220.18
| Professional | | $1,288.25 | $1,513.56 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $9,772.37 / $15,488.17
| Facility | | $8,317.64 | $9,772.37 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $7,585.78 / $9,549.93
| Professional | | $3,467.37 | $7,585.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $12,589.25 / $19,054.61
| Facility | | $3,311.31 | $12,589.25 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $19,952.62
| Professional | | $18,197.01 | $18,197.01 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,630.78 / $10,715.19
| Facility | | $2,754.23 | $3,630.78 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,819.70 / $15,135.61
| Professional | | $1,348.96 | $1,819.70 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $64.57 / $3,019.95
| Professional | | $50.12 | $64.57 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,079.46 / $10,000.00
| Professional | | $4,897.79 | $7,079.46 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $14,454.40 / $14,454.40
| Facility | | $6,025.60 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $15,135.61 / $15,135.61
| Professional | | $4,365.16 | $15,135.61 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $6,456.54 / $6,456.54
| Professional | | $6,456.54 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,595.87 / $22,908.68
| Professional | | $8,709.64 | $16,595.87 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $3,630.78
| Facility | | $2,398.83 | $2,398.83 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,819.70 / $5,011.87
| Professional | | $1,258.93 | $1,819.70 | $5,011.87 |