- 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
- $95.50 / $112.20 / $288.40
| Professional | | $95.50 | $112.20 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $3,981.07 / $19,498.45
| Facility | | $251.19 | $3,981.07 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $158.49 / $741.31
| Professional | | $87.10 | $158.49 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,737.80 / $1,737.80
| Professional | | $457.09 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $501.19 / $3,090.30
| Facility | | $446.68 | $501.19 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $169.82 / $354.81
| Professional | | $93.33 | $169.82 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $380.19 / $7,079.46
| Facility | | $100.00 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $144.54 / $213.80
| Professional | | $102.33 | $144.54 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,801.89 / $9,772.37
| Facility | | $524.81 | $3,801.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $181.97 / $281.84
| Professional | | $100.00 | $181.97 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $3,981.07 / $19,498.45
| Facility | | $251.19 | $3,981.07 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $154.88 / $741.31
| Professional | | $87.10 | $154.88 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,890.45 / $9,120.11
| Facility | | $1,071.52 | $3,890.45 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $147.91 / $309.03
| Professional | | $89.13 | $147.91 | $309.03 |