- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.10 / $1,233.57 / $5,320.00
| Facility | | $97.10 | $1,233.57 | $5,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,798.00 / $6,410.00 / $13,776.00
| Facility | | $3,798.00 | $6,410.00 | $13,776.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.07 / $123.58 / $142.56
| Facility | | $87.07 | $123.58 | $142.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.57 / $162.41 / $162.41
| Facility | | $120.57 | $162.41 | $162.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $5,592.00 / $10,966.00
| Facility | | $842.00 | $5,592.00 | $10,966.00 |