- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $766.94 / $3,200.00 / $5,577.92
| Facility | | $766.94 | $3,200.00 | $5,577.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,300.93 / $5,300.93 / $6,043.06
| Facility | | $5,300.93 | $5,300.93 | $6,043.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $559.14 / $776.63 / $960.88
| Facility | | $559.14 | $776.63 | $960.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.00 / $541.00 / $4,726.62
| Facility | | $515.00 | $541.00 | $4,726.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $3,635.00 / $8,676.00
| Facility | | $2,000.00 | $3,635.00 | $8,676.00 |