- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.40 / $2,318.00 / $18,761.45
| Facility | | $669.40 | $2,318.00 | $18,761.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $6,474.00 / $13,758.00
| Facility | | $2,318.00 | $6,474.00 | $13,758.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $666.04 / $914.17 / $1,371.26
| Facility | | $666.04 | $914.17 | $1,371.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,116.34 / $2,116.34 / $2,508.71
| Facility | | $2,116.34 | $2,116.34 | $2,508.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,846.00 / $8,348.00 / $12,569.00
| Facility | | $3,846.00 | $8,348.00 | $12,569.00 |