- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $642.58 / $3,785.00 / $10,268.00
| Facility | | $642.58 | $3,785.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.00 / $3,405.00 / $14,996.00
| Facility | | $1,712.00 | $3,405.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $713.00 / $1,038.23 / $1,038.23
| Facility | | $713.00 | $1,038.23 | $1,038.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $2,600.00 / $5,457.00
| Facility | | $1,689.00 | $2,600.00 | $5,457.00 |