- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $3,008.11 / $8,229.00
| Facility | | $860.00 | $3,008.11 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,584.00 / $10,990.10 / $30,856.09
| Facility | | $8,584.00 | $10,990.10 | $30,856.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,009.83 / $4,069.23 / $4,694.14
| Facility | | $3,009.83 | $4,069.23 | $4,694.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,601.21 / $3,601.21 / $3,809.54
| Facility | | $3,601.21 | $3,601.21 | $3,809.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $4,298.00 / $30,001.00
| Facility | | $599.00 | $4,298.00 | $30,001.00 |