- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.18 / $3,776.00 / $9,727.00
| Facility | | $291.18 | $3,776.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,184.19 / $4,445.64 / $7,690.56
| Facility | | $2,184.19 | $4,445.64 | $7,690.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $434.02 / $1,965.14
| Facility | | $375.00 | $434.02 | $1,965.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.33 / $477.34 / $801.91
| Facility | | $284.33 | $477.34 | $801.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,878.00 / $16,772.00
| Facility | | $1,550.00 | $10,878.00 | $16,772.00 |