- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.30 / $628.30 / $6,575.00
| Facility | | $628.30 | $628.30 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.58 / $11,886.97 / $26,854.33
| Facility | | $3,090.58 | $11,886.97 | $26,854.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,666.84 / $2,363.79 / $5,686.41
| Facility | | $1,666.84 | $2,363.79 | $5,686.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,355.02 / $2,161.07 / $4,477.49
| Facility | | $1,355.02 | $2,161.07 | $4,477.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $927.70 / $1,375.55 / $10,533.00
| Facility | | $927.70 | $1,375.55 | $10,533.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $8,689.00 / $11,531.00
| Facility | | $3,940.00 | $8,689.00 | $11,531.00 |