- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,194.00 / $9,747.41 / $15,171.00
| Facility | | $5,194.00 | $9,747.41 | $15,171.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,971.56 / $4,668.47 / $9,678.00
| Facility | | $2,971.56 | $4,668.47 | $9,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.26 / $761.49 / $846.10
| Professional | | $647.26 | $761.49 | $846.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,359.00 / $19,144.00 / $27,046.36
| Facility | | $14,359.00 | $19,144.00 | $27,046.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,706.00 / $11,710.00 / $21,600.00
| Facility | | $8,706.00 | $11,710.00 | $21,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.59 / $301.89 / $651.92
| Professional | | $203.59 | $301.89 | $651.92 |