- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $312.67 / $5,866.00 / $16,467.00
| Facility | | $312.67 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,070.59 / $5,275.08 / $8,915.54
| Facility | | $2,070.59 | $5,275.08 | $8,915.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,831.77 / $2,831.77 / $3,638.88
| Facility | | $2,831.77 | $2,831.77 | $3,638.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $312.67 / $492.00 / $665.00
| Facility | | $312.67 | $492.00 | $665.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |