- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,623.41 / $26,915.35
| Facility | | $2,344.23 | $5,623.41 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $776.25 / $10,232.93
| Professional | | $676.08 | $776.25 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $11,220.18 / $40,738.03
| Facility | | $2,691.53 | $11,220.18 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $17,378.01 / $23,442.29
| Facility | | $15,135.61 | $17,378.01 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $15,848.93 / $21,877.62
| Facility | | $7,762.47 | $15,848.93 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Professional | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,918.31 / $35,481.34
| Facility | | $2,691.53 | $6,918.31 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,498.45 / $26,302.68 / $33,884.42
| Professional | | $19,498.45 | $26,302.68 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $13,489.63 / $17,782.79
| Facility | | $13,489.63 | $13,489.63 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $11,220.18 / $40,738.03
| Facility | | $3,311.31 | $11,220.18 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,244.36 / $35,481.34
| Facility | | $2,691.53 | $7,244.36 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,498.45 / $25,703.96 / $33,113.11
| Professional | | $19,498.45 | $25,703.96 | $33,113.11 |