- 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
- $114.82 / $141.25 / $416.87
| Professional | | $114.82 | $141.25 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,884.03 / $19,498.45
| Facility | | $295.12 | $2,884.03 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $194.98 / $1,995.26
| Professional | | $114.82 | $194.98 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $245.47 / $436.52
| Professional | | $138.04 | $245.47 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $380.19 / $7,079.46
| Facility | | $114.82 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $128.82 / $190.55
| Professional | | $66.07 | $128.82 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,511.89 / $7,079.46
| Facility | | $1,096.48 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $218.78 / $354.81
| Professional | | $117.49 | $218.78 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,884.03 / $19,498.45
| Facility | | $295.12 | $2,884.03 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $186.21 / $524.81
| Professional | | $114.82 | $186.21 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,511.89 / $6,165.95
| Facility | | $1,047.13 | $2,511.89 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $213.80 / $426.58
| Professional | | $123.03 | $213.80 | $426.58 |