- 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
- $257.04 / $398.11 / $1,000.00
| Professional | | $257.04 | $398.11 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $5,888.44 / $19,498.45
| Facility | | $776.25 | $5,888.44 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $446.68 / $2,238.72
| Professional | | $245.47 | $446.68 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $660.69 / $1,174.90
| Professional | | $407.38 | $660.69 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $691.83 / $7,079.46
| Facility | | $316.23 | $691.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $457.09 / $630.96
| Professional | | $380.19 | $457.09 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $575.44 / $1,000.00
| Professional | | $323.59 | $575.44 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $5,888.44 / $19,498.45
| Facility | | $776.25 | $5,888.44 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $446.68 / $2,238.72
| Professional | | $245.47 | $446.68 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $11,220.18
| Facility | | $2,041.74 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $478.63 / $1,318.26
| Professional | | $323.59 | $478.63 | $1,318.26 |