- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,238.72 / $5,128.61
| Facility | | $1,000.00 | $2,238.72 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $758.58 / $3,715.35
| Professional | | $147.91 | $758.58 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,089.30 / $14,125.38
| Facility | | $56.23 | $2,089.30 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $1,380.38 / $5,011.87
| Professional | | $154.88 | $1,380.38 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $165.96 / $389.05
| Facility | | $165.96 | $165.96 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $977.24 / $3,801.89
| Professional | | $245.47 | $977.24 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $1,096.48 / $4,786.30
| Professional | | $208.93 | $1,096.48 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $218.78 / $7,079.46
| Facility | | $128.82 | $218.78 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,570.40 / $4,677.35
| Professional | | $2,089.30 | $2,570.40 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $1,698.24 / $4,265.80
| Professional | | $158.49 | $1,698.24 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Professional | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,089.30 / $14,125.38
| Facility | | $56.23 | $2,089.30 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $1,380.38 / $5,011.87
| Professional | | $154.88 | $1,380.38 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,165.95 / $15,488.17
| Facility | | $2,570.40 | $6,165.95 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $660.69 / $4,466.84
| Professional | | $186.21 | $660.69 | $4,466.84 |