- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.34 / $1,245.00 / $10,561.00
| Facility | | $607.34 | $1,245.00 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $2,710.28
| Facility | | $748.70 | $748.70 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.34 / $787.00 / $1,230.90
| Facility | | $607.34 | $787.00 | $1,230.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,629.00 / $8,549.00 / $13,997.00
| Facility | | $2,629.00 | $8,549.00 | $13,997.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,915.30 / $8,957.00 / $26,542.00
| Facility | | $2,915.30 | $8,957.00 | $26,542.00 |