- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.27 / $2,544.26 / $10,034.00
| Facility | | $903.27 | $2,544.26 | $10,034.00 |
- 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
- $590.01 / $883.58 / $1,333.76
| Facility | | $590.01 | $883.58 | $1,333.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,711.00 / $7,162.00 / $10,397.00
| Facility | | $1,711.00 | $7,162.00 | $10,397.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,293.96 / $8,957.00 / $26,542.00
| Facility | | $2,293.96 | $8,957.00 | $26,542.00 |