- 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
- $223.87 / $288.40 / $741.31
| Professional | | $223.87 | $288.40 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,905.46 / $7,943.28
| Facility | | $56.23 | $1,905.46 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $398.11 / $1,949.84
| Professional | | $229.09 | $398.11 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,737.80 / $1,737.80
| Professional | | $602.56 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $741.31 / $2,691.53
| Facility | | $199.53 | $741.31 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $389.05 / $741.31
| Professional | | $223.87 | $389.05 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $501.19 / $8,511.38
| Facility | | $295.12 | $501.19 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $426.58 / $588.84
| Professional | | $309.03 | $426.58 | $588.84 |
- 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
- $295.12 / $524.81 / $831.76
| Professional | | $295.12 | $524.81 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,905.46 / $7,943.28
| Facility | | $56.23 | $1,905.46 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $398.11 / $1,949.84
| Professional | | $229.09 | $398.11 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,548.13 / $8,511.38
| Facility | | $676.08 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $371.54 / $831.76
| Professional | | $229.09 | $371.54 | $831.76 |