- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $7,920.26 / $20,400.00
| Facility | | $2,747.00 | $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
- $2,810.46 / $3,297.03 / $3,949.41
| Professional | | $2,810.46 | $3,297.03 | $3,949.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,193.73 / $2,745.98 / $4,716.52
| Facility | | $2,193.73 | $2,745.98 | $4,716.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,019.16 / $2,967.11 / $3,076.64
| Facility | | $2,019.16 | $2,967.11 | $3,076.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.04 / $2,915.86 / $3,940.40
| Facility | | $2,084.04 | $2,915.86 | $3,940.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,898.62 / $20,285.91 / $26,041.52
| Facility | | $9,898.62 | $20,285.91 | $26,041.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $18,628.00 / $26,255.00
| Facility | | $3,028.00 | $18,628.00 | $26,255.00 |