- 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 / $281.84 / $724.44
| Professional | | $223.87 | $281.84 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,862.09 / $19,498.45
| Facility | | $501.19 | $1,862.09 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $380.19 / $2,754.23
| Professional | | $223.87 | $380.19 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $1,659.59
| Professional | | $478.63 | $478.63 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $398.11 / $630.96
| Professional | | $251.19 | $398.11 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $446.68 / $7,079.46
| Facility | | $213.80 | $446.68 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $288.40 / $407.38
| Professional | | $234.42 | $288.40 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $398.11 / $588.84
| Professional | | $218.78 | $398.11 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,862.09 / $19,498.45
| Facility | | $501.19 | $1,862.09 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $389.05 / $2,754.23
| Professional | | $223.87 | $389.05 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $380.19 / $691.83
| Professional | | $251.19 | $380.19 | $691.83 |