- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,344.23 / $3,801.89
| Facility | | $1,000.00 | $2,344.23 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $2,344.23 / $6,918.31
| Professional | | $151.36 | $2,344.23 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,370.32 / $16,595.87
| Facility | | $56.23 | $5,370.32 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $2,511.89 / $8,317.64
| Professional | | $190.55 | $2,511.89 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $467.74
| Facility | | $199.53 | $199.53 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $5,495.41
| Professional | | $346.74 | $346.74 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $2,398.83 / $7,943.28
| Professional | | $229.09 | $2,398.83 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $302.00 / $8,511.38
| Facility | | $147.91 | $302.00 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,890.45 / $7,413.10
| Professional | | $3,090.30 | $3,890.45 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,165.95 / $13,182.57
| Facility | | $2,511.89 | $6,165.95 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $2,630.27 / $6,606.93
| Professional | | $177.83 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $588.84
| Facility | | $331.13 | $331.13 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,888.44 / $16,595.87
| Facility | | $56.23 | $5,888.44 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $2,511.89 / $8,128.31
| Professional | | $190.55 | $2,511.89 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,309.57 / $13,803.84
| Facility | | $2,511.89 | $6,309.57 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $2,511.89 / $7,413.10
| Professional | | $218.78 | $2,511.89 | $7,413.10 |