- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $2,747.00 / $5,454.00
| Facility | | $2,663.12 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,237.00 / $7,775.00 / $21,140.00
| Facility | | $2,237.00 | $7,775.00 | $21,140.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $9,788.00 / $12,860.94
| Facility | | $3,000.00 | $9,788.00 | $12,860.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39,201.12 / $49,367.50 / $61,531.76
| Professional | | $39,201.12 | $49,367.50 | $61,531.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,237.00 / $7,775.00 / $21,140.00
| Facility | | $2,237.00 | $7,775.00 | $21,140.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,594.00 / $7,775.00 / $16,522.00
| Facility | | $2,594.00 | $7,775.00 | $16,522.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33,093.44 / $49,526.42 / $56,787.50
| Professional | | $33,093.44 | $49,526.42 | $56,787.50 |