- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.37 / $305.37 / $2,168.00
| Facility | | $305.37 | $305.37 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,597.22 / $6,373.77 / $12,643.17
| Facility | | $3,597.22 | $6,373.77 | $12,643.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.15 / $1,157.41 / $2,784.30
| Facility | | $816.15 | $1,157.41 | $2,784.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.47 / $1,058.15 / $2,192.36
| Facility | | $663.47 | $1,058.15 | $2,192.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.32 / $624.36 / $7,666.32
| Facility | | $383.32 | $624.36 | $7,666.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |