- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $8,709.64
| Facility | | $8,709.64 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,570.40 / $3,090.30
| Professional | | $2,238.72 | $2,570.40 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $7.41 / $11,220.18
| Professional | | $7.41 | $7.41 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $10,232.93 / $16,595.87
| Facility | | $8,709.64 | $10,232.93 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $8,128.31 / $10,000.00
| Professional | | $3,715.35 | $8,128.31 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $13,489.63 / $20,417.38
| Facility | | $3,235.94 | $13,489.63 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,054.61 / $19,054.61 / $21,379.62
| Professional | | $19,054.61 | $19,054.61 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $11,220.18
| Facility | | $2,884.03 | $3,801.89 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,905.46 / $15,848.93
| Professional | | $1,445.44 | $1,905.46 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $70.79 / $1,584.89
| Professional | | $50.12 | $70.79 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,585.78 / $10,471.29
| Professional | | $5,128.61 | $7,585.78 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $15,135.61 / $15,135.61
| Facility | | $6,456.54 | $15,135.61 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $12,882.50 / $15,848.93
| Professional | | $4,677.35 | $12,882.50 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $6,760.83
| Professional | | $6,760.83 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,378.01 / $17,378.01 / $17,378.01
| Professional | | $17,378.01 | $17,378.01 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $3,801.89
| Facility | | $2,570.40 | $2,570.40 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,905.46 / $5,248.07
| Professional | | $1,348.96 | $1,905.46 | $5,248.07 |