- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.42 / $341.42 / $6,575.00
| Facility | | $341.42 | $341.42 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,744.10 / $9,076.59 / $20,505.30
| Facility | | $1,744.10 | $9,076.59 | $20,505.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.21 / $1,245.80 / $2,996.93
| Facility | | $798.21 | $1,245.80 | $2,996.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.72 / $1,136.86 / $2,359.79
| Facility | | $691.72 | $1,136.86 | $2,359.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.60 / $712.09 / $4,660.72
| Facility | | $367.60 | $712.09 | $4,660.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.00 / $7,872.00 / $11,531.00
| Facility | | $2,960.00 | $7,872.00 | $11,531.00 |