- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $939.08 / $1,036.08 / $4,846.00
| Facility | | $939.08 | $1,036.08 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $11,226.46 / $15,429.17
| Facility | | $4,600.00 | $11,226.46 | $15,429.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.41 / $1,122.43 / $1,295.11
| Facility | | $863.41 | $1,122.43 | $1,295.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,114.58
| Facility | | $761.00 | $761.00 | $1,114.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $5,076.00 / $10,396.00
| Facility | | $612.00 | $5,076.00 | $10,396.00 |