- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $9,549.93 / $9,549.93
| Facility | | $4,168.69 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,884.03 / $4,168.69
| Professional | | $2,454.71 | $2,884.03 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $239.88 / $12,302.69
| Professional | | $204.17 | $239.88 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $11,220.18 / $17,782.79
| Facility | | $9,549.93 | $11,220.18 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $8,912.51 / $10,964.78
| Professional | | $3,981.07 | $8,912.51 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $14,791.08 / $22,387.21
| Facility | | $3,548.13 | $14,791.08 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,892.96 / $20,892.96 / $23,442.29
| Professional | | $20,892.96 | $20,892.96 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,168.69 / $12,302.69
| Facility | | $3,162.28 | $4,168.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,089.30 / $12,589.25
| Professional | | $1,584.89 | $2,089.30 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $70.79 / $3,467.37
| Professional | | $50.12 | $70.79 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $8,317.64 / $11,481.54
| Professional | | $5,623.41 | $8,317.64 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $16,595.87 / $16,595.87
| Facility | | $7,079.46 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $14,125.38 / $17,378.01
| Professional | | $5,128.61 | $14,125.38 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $7,413.10
| Professional | | $3,467.37 | $3,467.37 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $19,498.45
| Professional | | $3,467.37 | $3,467.37 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $4,168.69
| Facility | | $2,818.38 | $2,818.38 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,089.30 / $5,754.40
| Professional | | $1,479.11 | $2,089.30 | $5,754.40 |