- 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
- $158.49 / $190.55 / $575.44
| Professional | | $158.49 | $190.55 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,801.89 / $19,498.45
| Facility | | $446.68 | $3,801.89 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $269.15 / $1,288.25
| Professional | | $162.18 | $269.15 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $501.19 / $2,691.53
| Facility | | $446.68 | $501.19 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $281.84 / $537.03
| Professional | | $165.96 | $281.84 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $302.00 / $7,079.46
| Facility | | $177.83 | $302.00 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $263.03 / $371.54
| Professional | | $186.21 | $263.03 | $371.54 |
- 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
- $181.97 / $323.59 / $512.86
| Professional | | $181.97 | $323.59 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,801.89 / $19,498.45
| Facility | | $446.68 | $3,801.89 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $269.15 / $1,288.25
| Professional | | $165.96 | $269.15 | $1,288.25 |
- 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
- $162.18 / $251.19 / $537.03
| Professional | | $162.18 | $251.19 | $537.03 |