- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $7,244.36 / $11,220.18
| Facility | | $1,584.89 | $7,244.36 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $6,456.54 / $10,000.00
| Professional | | $831.76 | $6,456.54 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $891.25 / $1,445.44
| Professional | | $758.58 | $891.25 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $21,379.62
| Professional | | $12,589.25 | $12,589.25 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $1,479.11
| Professional | | $870.96 | $870.96 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107,151.93 / $107,151.93 / $107,151.93
| Facility | | $107,151.93 | $107,151.93 | $107,151.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $660.69
| Professional | | $512.86 | $512.86 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $6,165.95 / $11,220.18
| Facility | | $1,288.25 | $6,165.95 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $6,165.95 / $9,120.11
| Professional | | $831.76 | $6,165.95 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $741.31
| Facility | | $724.44 | $724.44 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $724.44 / $776.25
| Professional | | $501.19 | $724.44 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,128.31 / $56,234.13
| Facility | | $3,311.31 | $8,128.31 | $56,234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $933.25 / $10,964.78
| Professional | | $630.96 | $933.25 | $10,964.78 |