- 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
- $549.54 / $645.65 / $1,905.46
| Professional | | $549.54 | $645.65 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,398.83 / $12,589.25
| Facility | | $56.23 | $2,398.83 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $891.25 / $4,365.16
| Professional | | $457.09 | $891.25 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,096.48 / $2,089.30
| Professional | | $616.60 | $1,096.48 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,122.02 / $7,079.46
| Facility | | $380.19 | $1,122.02 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $602.56 / $912.01
| Professional | | $316.23 | $602.56 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,023.29 / $1,659.59
| Professional | | $575.44 | $1,023.29 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,162.28 / $12,589.25
| Facility | | $56.23 | $3,162.28 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $891.25 / $4,365.16
| Professional | | $457.09 | $891.25 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $10,715.19
| Facility | | $1,584.89 | $3,630.78 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $954.99 / $2,187.76
| Professional | | $645.65 | $954.99 | $2,187.76 |