- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,912.51 / $14,791.08
| Facility | | $2,951.21 | $8,912.51 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $3,467.37
| Professional | | $1,778.28 | $1,778.28 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $17,378.01 / $17,782.79
| Facility | | $8,912.51 | $17,378.01 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $288.40 / $478.63
| Professional | | $239.88 | $288.40 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.18 / $8,128.31 / $33,884.42
| Facility | | $69.18 | $8,128.31 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,630.27 / $5,754.40
| Professional | | $2,041.74 | $2,630.27 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,570.88 / $11,748.98
| Facility | | $2,290.87 | $4,570.88 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,890.45 / $5,248.07
| Professional | | $3,467.37 | $3,890.45 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,890.45 / $6,165.95
| Professional | | $3,162.28 | $3,890.45 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $16,595.87
| Facility | | $16,595.87 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,378.01 / $26,302.68 / $26,302.68
| Professional | | $17,378.01 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,168.69 / $9,120.11
| Facility | | $2,290.87 | $4,168.69 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,890.45 / $3,890.45
| Professional | | $3,467.37 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,890.45 / $52,480.75
| Professional | | $2,818.38 | $3,890.45 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,467.37 / $3,467.37
| Facility | | $1,479.11 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $6,760.83
| Professional | | $1,479.11 | $1,479.11 | $6,760.83 |