- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $14,454.40 / $14,454.40
| Facility | | $14,454.40 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,168.69 / $5,011.87
| Professional | | $3,162.28 | $4,168.69 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,905.46 / $18,197.01
| Professional | | $1,621.81 | $1,905.46 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $16,982.44 / $26,915.35
| Facility | | $14,454.40 | $16,982.44 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $13,182.57 / $16,218.10
| Professional | | $6,025.60 | $13,182.57 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $21,877.62 / $33,113.11
| Facility | | $5,370.32 | $21,877.62 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,622.78 / $31,622.78 / $34,673.69
| Professional | | $31,622.78 | $31,622.78 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,309.57 / $18,197.01
| Facility | | $4,677.35 | $6,309.57 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,162.28 / $26,302.68
| Professional | | $2,344.23 | $3,162.28 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $64.57 / $85.11
| Professional | | $50.12 | $64.57 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $12,302.69 / $17,378.01
| Professional | | $8,511.38 | $12,302.69 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $24,547.09 / $24,547.09
| Facility | | $10,471.29 | $24,547.09 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $20,892.96 / $26,302.68
| Professional | | $7,585.78 | $20,892.96 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Professional | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,542.29 / $28,840.32 / $28,840.32
| Professional | | $27,542.29 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $6,309.57
| Facility | | $4,168.69 | $4,168.69 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,162.28 / $8,709.64
| Professional | | $2,187.76 | $3,162.28 | $8,709.64 |