- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.28 / $654.28 / $4,828.00
| Facility | | $654.28 | $654.28 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,246.57 / $2,868.68 / $6,480.74
| Facility | | $1,246.57 | $2,868.68 | $6,480.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,658.42 / $2,351.84 / $5,657.68
| Facility | | $1,658.42 | $2,351.84 | $5,657.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.17 / $2,150.15 / $4,454.85
| Facility | | $1,348.17 | $2,150.15 | $4,454.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.30 / $1,109.08 / $3,500.00
| Facility | | $700.30 | $1,109.08 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,296.00 / $3,500.00 / $6,361.00
| Facility | | $2,296.00 | $3,500.00 | $6,361.00 |