- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,888.44 / $5,888.44
| Facility | | $2,570.40 | $5,888.44 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,778.28 / $2,570.40
| Professional | | $1,412.54 | $1,778.28 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $13.18 / $7,413.10
| Professional | | $11.22 | $13.18 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $10,964.78
| Facility | | $5,888.44 | $6,760.83 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,370.32 / $6,606.93
| Professional | | $2,454.71 | $5,370.32 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $8,912.51 / $13,489.63
| Facility | | $2,344.23 | $8,912.51 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,882.50 / $12,882.50 / $14,125.38
| Professional | | $12,882.50 | $12,882.50 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,570.40 / $7,413.10
| Facility | | $1,905.46 | $2,570.40 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,288.25 / $7,585.78
| Professional | | $954.99 | $1,288.25 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $64.57 / $1,071.52
| Professional | | $50.12 | $64.57 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,011.87 / $7,079.46
| Professional | | $3,467.37 | $5,011.87 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $10,000.00 / $10,000.00
| Facility | | $4,265.80 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $8,511.38 / $10,471.29
| Professional | | $3,090.30 | $8,511.38 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $4,570.88
| Professional | | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,481.54 / $11,481.54
| Professional | | $11,220.18 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $2,570.40
| Facility | | $1,698.24 | $1,698.24 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,288.25 / $3,548.13
| Professional | | $891.25 | $1,288.25 | $3,548.13 |