- 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
- $234.42 / $309.03 / $724.44
| Professional | | $234.42 | $309.03 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,162.28 / $19,498.45
| Facility | | $602.56 | $3,162.28 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $426.58 / $4,168.69
| Professional | | $239.88 | $426.58 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $436.52 / $977.24
| Professional | | $281.84 | $436.52 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $467.74 / $7,079.46
| Facility | | $229.09 | $467.74 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $309.03 / $426.58
| Professional | | $245.47 | $309.03 | $426.58 |
- 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
- $245.47 / $426.58 / $707.95
| Professional | | $245.47 | $426.58 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,162.28 / $19,498.45
| Facility | | $602.56 | $3,162.28 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $426.58 / $1,778.28
| Professional | | $239.88 | $426.58 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $436.52 / $1,000.00
| Professional | | $269.15 | $436.52 | $1,000.00 |