- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $697.11 / $2,318.00 / $11,093.00
| Facility | | $697.11 | $2,318.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,140.00 / $5,948.00 / $9,462.00
| Facility | | $2,140.00 | $5,948.00 | $9,462.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $703.06 / $926.39 / $1,389.59
| Facility | | $703.06 | $926.39 | $1,389.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.45 / $1,123.45 / $1,331.74
| Facility | | $1,123.45 | $1,123.45 | $1,331.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,582.00 / $12,569.00
| Facility | | $3,932.00 | $8,582.00 | $12,569.00 |