- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.38 / $956.75 / $2,500.00
| Facility | | $144.38 | $956.75 | $2,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.37 / $211.37 / $253.64
| Facility | | $211.37 | $211.37 | $253.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.75 / $207.75 / $207.75
| Facility | | $207.75 | $207.75 | $207.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.76 / $247.76 / $247.76
| Facility | | $247.76 | $247.76 | $247.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $360.00 / $768.00
| Facility | | $130.00 | $360.00 | $768.00 |