- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $10,232.93 / $11,748.98
| Facility | | $5,128.61 | $10,232.93 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $8,912.51 / $11,748.98
| Professional | | $707.95 | $8,912.51 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $7,244.36 / $17,782.79
| Facility | | $707.95 | $7,244.36 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.03
| Professional | | $0.02 | $0.02 | $0.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60,255.96 / $72,443.60 / $79,432.82
| Facility | | $60,255.96 | $72,443.60 | $79,432.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75,857.76 / $75,857.76 / $79,432.82
| Professional | | $75,857.76 | $75,857.76 | $79,432.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $524.81 / $21,379.62
| Facility | | $34.67 | $524.81 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Professional | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $562.34 / $21,379.62
| Facility | | $426.58 | $562.34 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Professional | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $33.11 / $60.26
| Professional | | $30.20 | $33.11 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $870.96
| Facility | | $100.00 | $100.00 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $70.79 / $75.86
| Professional | | $50.12 | $70.79 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,698.24 / $3,981.07
| Facility | | $489.78 | $1,698.24 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Professional | | $512.86 | $512.86 | $512.86 |