- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,951.21 / $7,413.10
| Facility | | $707.95 | $2,951.21 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,162.28 / $5,754.40
| Facility | | $1,737.80 | $3,162.28 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $85.11 / $144.54
| Facility | | $85.11 | $85.11 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,318.26
| Facility | | $1,258.93 | $1,258.93 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $28,840.32 / $28,840.32
| Facility | | $5,754.40 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $173.78 / $3,801.89
| Facility | | $100.00 | $173.78 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $151.36 / $239.88
| Facility | | $95.50 | $151.36 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,698.24 / $4,168.69
| Facility | | $407.38 | $1,698.24 | $4,168.69 |