- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.06 / $6,548.00 / $16,467.00
| Facility | | $695.06 | $6,548.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.00 / $5,354.74 / $9,761.96
| Facility | | $1,058.00 | $5,354.74 | $9,761.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $661.01 / $3,845.77
| Facility | | $375.00 | $661.01 | $3,845.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.16 / $695.06 / $1,181.59
| Facility | | $516.16 | $695.06 | $1,181.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.00 / $10,069.00 / $16,249.00
| Facility | | $710.00 | $10,069.00 | $16,249.00 |