- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $1,000.00 / $1,000.00
| Facility | | $77.62 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,630.78 / $8,709.64
| Facility | | $501.19 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,715.35 / $8,912.51
| Facility | | $2,344.23 | $3,715.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,548.13 / $7,079.46
| Facility | | $2,884.03 | $3,548.13 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $891.25 / $2,754.23
| Facility | | $91.20 | $891.25 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,467.37 / $6,760.83
| Facility | | $1,230.27 | $3,467.37 | $6,760.83 |