- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $906.22 / $3,660.00 / $10,268.00
| Facility | | $906.22 | $3,660.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,003.00 / $3,555.00 / $19,117.00
| Facility | | $2,003.00 | $3,555.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $577.86 / $693.43 / $858.27
| Facility | | $577.86 | $693.43 | $858.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,840.00 / $5,998.00 / $7,847.00
| Facility | | $2,840.00 | $5,998.00 | $7,847.00 |