- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $34,673.69 / $57,543.99
| Facility | | $11,748.98 | $34,673.69 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,918.31 / $8,912.51
| Professional | | $5,128.61 | $6,918.31 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $42,657.95 / $42,657.95
| Facility | | $21,379.62 | $42,657.95 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $346.74 / $10,232.93
| Professional | | $208.93 | $346.74 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $19,952.62 / $83,176.38
| Facility | | $61.66 | $19,952.62 | $83,176.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,456.54 / $16,595.87
| Professional | | $4,897.79 | $6,456.54 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $14,125.38 / $28,183.83
| Facility | | $5,623.41 | $14,125.38 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $9,332.54 / $11,481.54
| Professional | | $8,511.38 | $9,332.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $9,332.54 / $14,791.08
| Professional | | $7,585.78 | $9,332.54 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,810.72 / $39,810.72 / $39,810.72
| Facility | | $39,810.72 | $39,810.72 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41,686.94 / $63,095.73 / $63,095.73
| Professional | | $41,686.94 | $63,095.73 | $63,095.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $10,232.93 / $21,877.62
| Facility | | $6,456.54 | $10,232.93 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $9,332.54 / $12,302.69
| Professional | | $8,511.38 | $9,332.54 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $7,585.78 / $8,511.38
| Professional | | $6,760.83 | $7,585.78 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,511.38 / $8,511.38
| Facility | | $3,548.13 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,659.59 / $9,549.93
| Professional | | $1,548.82 | $1,659.59 | $9,549.93 |