- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,475.92 / $3,078.79 / $7,920.26
| Facility | | $2,475.92 | $3,078.79 | $7,920.26 |
- 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
- $2,295.27 / $2,703.02 / $3,225.44
| Professional | | $2,295.27 | $2,703.02 | $3,225.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.53 / $2,275.62 / $3,049.80
| Facility | | $1,732.53 | $2,275.62 | $3,049.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,767.94 / $2,380.27 / $2,541.98
| Facility | | $1,767.94 | $2,380.27 | $2,541.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.53 / $2,373.57 / $3,227.31
| Facility | | $1,732.53 | $2,373.57 | $3,227.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,802.20 / $51,381.00 / $65,959.06
| Facility | | $23,802.20 | $51,381.00 | $65,959.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $26,100.00 / $51,981.00
| Facility | | $3,340.00 | $26,100.00 | $51,981.00 |