- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,210.00 / $6,140.00
| Facility | | $1,000.00 | $4,210.00 | $6,140.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,050.00 / $1,900.00
| Professional | | $1,000.00 | $1,050.00 | $1,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.69 / $325.48 / $6,837.70
| Facility | | $128.69 | $325.48 | $6,837.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.84 / $199.09 / $1,888.62
| Professional | | $76.84 | $199.09 | $1,888.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.77 / $90.77 / $90.77
| Facility | | $90.77 | $90.77 | $90.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,688.26 / $2,422.59 / $10,866.97
| Facility | | $1,688.26 | $2,422.59 | $10,866.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.39 / $691.74 / $2,098.00
| Professional | | $469.39 | $691.74 | $2,098.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,320.10 / $6,897.90 / $6,897.90
| Facility | | $1,320.10 | $6,897.90 | $6,897.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,226.72 / $4,226.72 / $5,767.95
| Professional | | $4,226.72 | $4,226.72 | $5,767.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.55 / $1,080.00 / $2,980.32
| Facility | | $93.55 | $1,080.00 | $2,980.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.77 / $164.29 / $625.86
| Professional | | $90.77 | $164.29 | $625.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.89 / $129.29 / $198.86
| Professional | | $60.89 | $129.29 | $198.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.63 / $1,387.10 / $3,052.80
| Facility | | $93.63 | $1,387.10 | $3,052.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.19 / $691.74 / $2,098.00
| Professional | | $410.19 | $691.74 | $2,098.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.76 / $2,412.01 / $4,430.58
| Professional | | $1,995.76 | $2,412.01 | $4,430.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,600.91 / $1,772.58 / $2,549.57
| Professional | | $1,600.91 | $1,772.58 | $2,549.57 |