- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.75 / $6,273.05 / $16,639.00
| Facility | | $752.75 | $6,273.05 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,949.60 / $10,977.63 / $19,346.00
| Facility | | $4,949.60 | $10,977.63 | $19,346.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $669.58 / $2,581.96
| Facility | | $580.00 | $669.58 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $644.52 / $814.77 / $1,287.22
| Facility | | $644.52 | $814.77 | $1,287.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |