- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $18,620.87 / $18,620.87
| Facility | | $18,620.87 | $18,620.87 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,370.32 / $6,606.93
| Professional | | $4,677.35 | $5,370.32 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $23,988.33
| Professional | | $426.58 | $426.58 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $21,877.62 / $34,673.69
| Facility | | $18,620.87 | $21,877.62 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $16,982.44 / $20,892.96
| Professional | | $7,762.47 | $16,982.44 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $28,183.83 / $42,657.95
| Facility | | $6,918.31 | $28,183.83 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40,738.03 / $40,738.03 / $44,668.36
| Professional | | $40,738.03 | $40,738.03 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,128.31 / $23,442.29
| Facility | | $6,025.60 | $8,128.31 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,073.80 / $33,884.42
| Professional | | $3,019.95 | $4,073.80 | $33,884.42 |
- 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
- $10,964.78 / $15,848.93 / $22,387.21
| Professional | | $10,964.78 | $15,848.93 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $32,359.37 / $32,359.37
| Facility | | $13,489.63 | $32,359.37 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $26,915.35 / $33,884.42
| Professional | | $9,772.37 | $26,915.35 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,454.40 / $14,454.40 / $14,454.40
| Professional | | $14,454.40 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37,153.52 / $37,153.52 / $37,153.52
| Professional | | $37,153.52 | $37,153.52 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $8,128.31
| Facility | | $5,370.32 | $5,370.32 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,073.80 / $11,220.18
| Professional | | $2,818.38 | $4,073.80 | $11,220.18 |