- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $423.88 / $1,920.90 / $6,575.00
| Facility | | $423.88 | $1,920.90 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,010.16 / $5,793.48 / $11,503.06
| Facility | | $2,010.16 | $5,793.48 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,111.18 / $6,416.50 / $15,435.77
| Facility | | $4,111.18 | $6,416.50 | $15,435.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,678.21 / $5,866.22 / $12,154.15
| Facility | | $3,678.21 | $5,866.22 | $12,154.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $573.45 / $1,920.90 / $5,061.60
| Facility | | $573.45 | $1,920.90 | $5,061.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |