- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.45 / $1,520.00 / $3,685.00
| Facility | | $546.45 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.40 / $5,842.14 / $10,692.30
| Facility | | $2,699.40 | $5,842.14 | $10,692.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $421.66 / $1,489.08 / $1,489.08
| Facility | | $421.66 | $1,489.08 | $1,489.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |