- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,585.78 / $18,197.01
| Facility | | $3,311.31 | $7,585.78 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,238.72 / $7,585.78
| Professional | | $1,348.96 | $2,238.72 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $10,715.19 / $17,782.79
| Facility | | $6,025.60 | $10,715.19 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,168.69 / $6,309.57
| Professional | | $1,288.25 | $4,168.69 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $7,079.46 / $22,908.68
| Facility | | $61.66 | $7,079.46 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Professional | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $7,079.46 / $7,079.46
| Professional | | $398.11 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $43,651.58
| Facility | | $43,651.58 | $43,651.58 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,904.51 / $46,773.51 / $46,773.51
| Professional | | $38,904.51 | $46,773.51 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,677.35 / $10,964.78
| Facility | | $1,737.80 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,548.13
| Professional | | $3,467.37 | $3,467.37 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $17,782.79 / $38,904.51
| Facility | | $9,549.93 | $17,782.79 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,479.11 / $5,011.87
| Professional | | $977.24 | $1,479.11 | $5,011.87 |