- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,519.48 / $7,920.26 / $20,400.00
| Facility | | $2,519.48 | $7,920.26 | $20,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $842.00 / $842.00
| Facility | | $842.00 | $842.00 | $842.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,338.08 / $2,745.14 / $3,285.60
| Professional | | $2,338.08 | $2,745.14 | $3,285.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,769.09 / $2,285.94 / $3,803.54
| Facility | | $1,769.09 | $2,285.94 | $3,803.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,784.45 / $2,453.54 / $2,557.39
| Facility | | $1,784.45 | $2,453.54 | $2,557.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,680.64 / $2,388.27 / $3,252.20
| Facility | | $1,680.64 | $2,388.27 | $3,252.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,744.62 / $7,674.09 / $9,851.42
| Facility | | $3,744.62 | $7,674.09 | $9,851.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $9,074.00 / $12,786.00
| Facility | | $1,981.00 | $9,074.00 | $12,786.00 |