- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.06 / $412.06 / $2,525.00
| Facility | | $412.06 | $412.06 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,890.50 / $4,787.28 / $9,978.29
| Facility | | $1,890.50 | $4,787.28 | $9,978.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.57 / $1,508.57 / $3,629.07
| Facility | | $966.57 | $1,508.57 | $3,629.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.62 / $1,376.67 / $2,857.54
| Facility | | $837.62 | $1,376.67 | $2,857.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.00 / $747.58 / $1,354.66
| Facility | | $392.00 | $747.58 | $1,354.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.00 / $4,746.00 / $8,812.00
| Facility | | $1,623.00 | $4,746.00 | $8,812.00 |