- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $2,570.40 / $10,715.19
| Facility | | $407.38 | $2,570.40 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,548.13 / $16,982.44
| Facility | | $1,548.82 | $3,548.13 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $316.23 / $354.81
| Facility | | $295.12 | $316.23 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $6,606.93
| Facility | | $100.00 | $100.00 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,365.16 / $7,413.10
| Facility | | $2,570.40 | $4,365.16 | $7,413.10 |