- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.11 / $746.11 / $6,575.00
| Facility | | $746.11 | $746.11 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,579.72 / $3,744.92 / $8,304.51
| Facility | | $1,579.72 | $3,744.92 | $8,304.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.54 / $2,465.31 / $5,930.65
| Facility | | $1,737.54 | $2,465.31 | $5,930.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,413.22 / $2,253.89 / $4,669.80
| Facility | | $1,413.22 | $2,253.89 | $4,669.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.79 / $1,319.52 / $5,625.11
| Facility | | $768.79 | $1,319.52 | $5,625.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |