- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $547.15 / $547.15 / $2,168.00
| Facility | | $547.15 | $547.15 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,172.06 / $5,762.11 / $12,749.70
| Facility | | $1,172.06 | $5,762.11 | $12,749.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.70 / $2,006.65 / $4,827.27
| Facility | | $1,285.70 | $2,006.65 | $4,827.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,114.18 / $1,831.20 / $3,801.00
| Facility | | $1,114.18 | $1,831.20 | $3,801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.70 / $996.66 / $1,821.86
| Facility | | $546.70 | $996.66 | $1,821.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $5,499.00 / $9,810.00
| Facility | | $2,100.00 | $5,499.00 | $9,810.00 |