- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.85 / $1,615.00 / $10,561.00
| Facility | | $738.85 | $1,615.00 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $1,438.74
| Facility | | $748.70 | $748.70 | $1,438.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.85 / $1,032.44 / $1,681.00
| Facility | | $738.85 | $1,032.44 | $1,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,863.96 / $4,754.80 / $26,542.00
| Facility | | $2,863.96 | $4,754.80 | $26,542.00 |