- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $11,220.18 / $13,182.57
| Facility | | $489.78 | $11,220.18 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,862.09 / $9,772.37
| Professional | | $489.78 | $1,862.09 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $16,218.10 / $27,542.29
| Facility | | $11,748.98 | $16,218.10 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,380.38 / $6,760.83
| Professional | | $724.44 | $1,380.38 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $18,197.01 / $28,840.32
| Facility | | $15,488.17 | $18,197.01 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $2,398.83 / $27,542.29
| Professional | | $812.83 | $2,398.83 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $6,309.57 / $12,302.69
| Facility | | $524.81 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,698.24 / $15,135.61
| Professional | | $912.01 | $1,698.24 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $6,918.31 / $15,135.61
| Facility | | $537.03 | $6,918.31 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $13,182.57 / $52,480.75
| Professional | | $7,244.36 | $13,182.57 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $6,456.54 / $19,054.61
| Professional | | $891.25 | $6,456.54 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $13,489.63 / $19,952.62
| Facility | | $7,244.36 | $13,489.63 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $14,454.40 / $52,480.75
| Professional | | $912.01 | $14,454.40 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $19,952.62 / $36,307.81
| Professional | | $2,137.96 | $19,952.62 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $17,782.79
| Facility | | $8,912.51 | $13,803.84 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $5,495.41 / $23,442.29
| Professional | | $602.56 | $5,495.41 | $23,442.29 |