- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.55 / $1,386.00 / $7,212.00
| Facility | | $245.55 | $1,386.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $5,126.00 / $8,240.00
| Facility | | $2,234.00 | $5,126.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.42 / $310.25 / $357.98
| Facility | | $243.42 | $310.25 | $357.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.40 / $2,218.40 / $2,218.40
| Facility | | $2,218.40 | $2,218.40 | $2,218.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,890.46 / $5,174.00 / $9,243.00
| Facility | | $2,890.46 | $5,174.00 | $9,243.00 |