- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,238.72 / $3,801.89
| Facility | | $1,000.00 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $245.47 / $870.96
| Professional | | $165.96 | $245.47 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $4,677.35 / $19,498.45
| Facility | | $524.81 | $4,677.35 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $302.00 / $1,862.09
| Professional | | $181.97 | $302.00 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Professional | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $416.87 / $776.25
| Professional | | $190.55 | $416.87 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $426.58 / $7,079.46
| Facility | | $199.53 | $426.58 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $281.84 / $467.74
| Professional | | $223.87 | $281.84 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $371.54 / $602.56
| Professional | | $204.17 | $371.54 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $4,677.35 / $19,498.45
| Facility | | $524.81 | $4,677.35 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $295.12 / $1,862.09
| Professional | | $181.97 | $295.12 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $316.23 / $707.95
| Professional | | $229.09 | $316.23 | $707.95 |