- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.54 / $3,158.00 / $9,304.00
| Facility | | $677.54 | $3,158.00 | $9,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,654.00 / $12,271.00 / $12,297.00
| Facility | | $8,654.00 | $12,271.00 | $12,297.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.43 / $257.43 / $257.43
| Facility | | $257.43 | $257.43 | $257.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.60 / $547.24 / $1,220.49
| Facility | | $163.60 | $547.24 | $1,220.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.00 / $815.00 / $1,300.00
| Facility | | $245.00 | $815.00 | $1,300.00 |