- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $5,100.00 / $20,664.30
| Facility | | $789.00 | $5,100.00 | $20,664.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,118.55 / $16,796.98 / $20,545.25
| Facility | | $15,118.55 | $16,796.98 | $20,545.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $16,107.32 / $24,863.13
| Facility | | $2,089.36 | $16,107.32 | $24,863.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,624.52 / $20,544.91 / $27,452.66
| Facility | | $13,624.52 | $20,544.91 | $27,452.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,818.17 / $22,450.54 / $32,936.44
| Facility | | $14,818.17 | $22,450.54 | $32,936.44 |