- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,370.32 / $5,370.32
| Facility | | $2,344.23 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,548.82 / $2,344.23
| Professional | | $1,288.25 | $1,548.82 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,148.15 / $7,585.78
| Professional | | $977.24 | $1,148.15 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,309.57 / $10,000.00
| Facility | | $5,370.32 | $6,309.57 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,897.79 / $6,025.60
| Professional | | $2,238.72 | $4,897.79 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $8,128.31 / $12,302.69
| Facility | | $2,137.96 | $8,128.31 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $12,882.50
| Professional | | $11,748.98 | $11,748.98 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,344.23 / $6,760.83
| Facility | | $1,737.80 | $2,344.23 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,174.90 / $9,772.37
| Professional | | $870.96 | $1,174.90 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $64.57 / $1,949.84
| Professional | | $50.12 | $64.57 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,570.88 / $6,456.54
| Professional | | $3,162.28 | $4,570.88 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $9,332.54 / $9,332.54
| Facility | | $3,890.45 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,762.47 / $9,772.37
| Professional | | $2,818.38 | $7,762.47 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $4,168.69
| Professional | | $4,168.69 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,715.19 / $10,715.19
| Professional | | $10,232.93 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $2,344.23
| Facility | | $1,548.82 | $1,548.82 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,174.90 / $3,235.94
| Professional | | $812.83 | $1,174.90 | $3,235.94 |