- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.25 / $570.25 / $2,525.00
| Facility | | $570.25 | $570.25 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,646.55 / $5,939.08 / $11,966.76
| Facility | | $2,646.55 | $5,939.08 | $11,966.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.49 / $1,967.23 / $4,732.45
| Facility | | $1,386.49 | $1,967.23 | $4,732.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.45 / $1,798.52 / $3,726.34
| Facility | | $1,260.45 | $1,798.52 | $3,726.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.80 / $990.27 / $3,293.00
| Facility | | $588.80 | $990.27 | $3,293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $7,823.25 / $10,734.22
| Facility | | $3,121.00 | $7,823.25 | $10,734.22 |