- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $7,943.28 / $7,943.28
| Facility | | $3,467.37 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,398.83 / $3,467.37
| Professional | | $2,041.74 | $2,398.83 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,174.90 / $9,120.11
| Professional | | $1,000.00 | $1,174.90 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $9,332.54 / $15,135.61
| Facility | | $7,943.28 | $9,332.54 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $7,413.10 / $9,120.11
| Professional | | $3,388.44 | $7,413.10 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $12,302.69 / $18,620.87
| Facility | | $3,235.94 | $12,302.69 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,378.01 / $17,378.01 / $19,498.45
| Professional | | $17,378.01 | $17,378.01 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,467.37 / $10,232.93
| Facility | | $2,630.27 | $3,467.37 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,737.80 / $14,454.40
| Professional | | $1,318.26 | $1,737.80 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $64.57 / $2,951.21
| Professional | | $50.12 | $64.57 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,918.31 / $9,549.93
| Professional | | $4,677.35 | $6,918.31 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $13,803.84 / $13,803.84
| Facility | | $5,888.44 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $14,454.40 / $14,454.40
| Professional | | $4,265.80 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,165.95 / $6,165.95
| Professional | | $6,165.95 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $15,848.93 / $22,387.21
| Professional | | $8,511.38 | $15,848.93 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $3,467.37
| Facility | | $2,344.23 | $2,344.23 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,737.80 / $4,786.30
| Professional | | $1,230.27 | $1,737.80 | $4,786.30 |