- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $22,387.21 / $38,018.94
| Facility | | $7,585.78 | $22,387.21 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,466.84 / $5,754.40
| Professional | | $3,311.31 | $4,466.84 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $27,542.29 / $27,542.29
| Facility | | $13,803.84 | $27,542.29 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,454.71 / $11,220.18
| Professional | | $1,698.24 | $2,454.71 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $11,748.98 / $15,488.17
| Facility | | $100.00 | $11,748.98 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,168.69 / $9,120.11
| Professional | | $3,235.94 | $4,168.69 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,079.46 / $17,782.79
| Facility | | $3,630.78 | $7,079.46 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $6,025.60 / $7,413.10
| Professional | | $5,495.41 | $6,025.60 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,025.60 / $9,549.93
| Professional | | $4,897.79 | $6,025.60 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $26,302.68 / $26,302.68
| Facility | | $26,302.68 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,542.29 / $40,738.03 / $40,738.03
| Professional | | $27,542.29 | $40,738.03 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,606.93 / $12,589.25
| Facility | | $3,981.07 | $6,606.93 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $6,025.60 / $6,025.60
| Professional | | $5,495.41 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,495.41 / $5,495.41
| Facility | | $2,290.87 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $10,471.29
| Professional | | $2,290.87 | $2,290.87 | $10,471.29 |