- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,290.87 / $3,801.89
| Facility | | $1,000.00 | $2,290.87 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $478.63 / $977.24
| Professional | | $177.83 | $478.63 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,096.48 / $4,786.30
| Facility | | $56.23 | $1,096.48 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $549.54 / $1,584.89
| Professional | | $194.98 | $549.54 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $489.78
| Facility | | $208.93 | $208.93 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $851.14 / $851.14
| Professional | | $501.19 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $741.31 / $1,905.46
| Facility | | $676.08 | $741.31 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $478.63 / $1,412.54
| Professional | | $204.17 | $478.63 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $302.00 / $8,511.38
| Facility | | $165.96 | $302.00 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $933.25 / $1,288.25
| Professional | | $660.69 | $933.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,162.28 / $8,511.38
| Facility | | $616.60 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $616.60 / $1,548.82
| Professional | | $194.98 | $616.60 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,096.48 / $4,786.30
| Facility | | $56.23 | $1,096.48 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $549.54 / $1,659.59
| Professional | | $194.98 | $549.54 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,019.95 / $8,511.38
| Facility | | $812.83 | $3,019.95 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $524.81 / $1,445.44
| Professional | | $194.98 | $524.81 | $1,445.44 |