- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,499.00 / $5,958.00 / $10,527.00
| Facility | | $1,499.00 | $5,958.00 | $10,527.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.75 / $6,648.17 / $10,124.45
| Professional | | $922.75 | $6,648.17 | $10,124.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.81 / $886.83 / $1,453.93
| Professional | | $753.81 | $886.83 | $1,453.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,311.26 / $12,311.26 / $19,784.11
| Professional | | $12,311.26 | $12,311.26 | $19,784.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104,745.74 / $104,745.74 / $104,745.74
| Facility | | $104,745.74 | $104,745.74 | $104,745.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.72 / $513.72 / $513.72
| Professional | | $513.72 | $513.72 | $513.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,426.00 / $5,958.00 / $11,182.00
| Facility | | $1,426.00 | $5,958.00 | $11,182.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $837.19 / $5,958.00 / $10,011.87
| Professional | | $837.19 | $5,958.00 | $10,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.49 / $739.51 / $739.51
| Facility | | $729.49 | $739.51 | $739.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.49 / $739.51 / $11,422.99
| Professional | | $729.49 | $739.51 | $11,422.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $7,000.00 / $12,076.00
| Facility | | $3,340.00 | $7,000.00 | $12,076.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.11 / $942.60 / $1,962.32
| Professional | | $615.11 | $942.60 | $1,962.32 |