- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,238.72 / $5,888.44
| Facility | | $1,000.00 | $2,238.72 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,737.80 / $2,041.74
| Professional | | $1,659.59 | $1,737.80 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $758.58 / $5,011.87
| Facility | | $645.65 | $758.58 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Professional | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Professional | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,737.80 / $2,290.87
| Professional | | $1,479.11 | $1,737.80 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,511.89 / $2,630.27
| Professional | | $1,659.59 | $2,511.89 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $3,715.35
| Facility | | $467.74 | $467.74 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,238.72 / $10,715.19
| Facility | | $1,000.00 | $2,238.72 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,737.80 / $2,089.30
| Professional | | $1,659.59 | $1,737.80 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.60 / $851.14 / $1,023.29
| Professional | | $0.60 | $851.14 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $588.84 / $1,905.46
| Facility | | $239.88 | $588.84 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $588.84 / $1,905.46
| Professional | | $239.88 | $588.84 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $933.25
| Facility | | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $2,137.96
| Professional | | $1,698.24 | $1,698.24 | $2,137.96 |