- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $5,011.87
| Facility | | $1,000.00 | $1,000.00 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,047.13 / $1,905.46
| Professional | | $912.01 | $1,047.13 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,244.36 / $20,417.38
| Facility | | $4,466.84 | $7,244.36 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,398.83 / $3,715.35
| Professional | | $1,621.81 | $2,398.83 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,548.13 / $8,511.38
| Facility | | $2,511.89 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,884.03 / $4,365.16
| Professional | | $1,737.80 | $2,884.03 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,467.37 / $6,760.83
| Facility | | $2,754.23 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,454.71 / $3,890.45
| Professional | | $1,862.09 | $2,454.71 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,862.09 / $3,981.07
| Facility | | $1,047.13 | $1,862.09 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,949.84 / $5,495.41
| Professional | | $977.24 | $1,949.84 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,715.35 / $7,079.46
| Facility | | $1,905.46 | $3,715.35 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,819.70 / $3,548.13
| Professional | | $977.24 | $1,819.70 | $3,548.13 |