- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.50 / $3,500.00 / $7,212.00
| Facility | | $181.50 | $3,500.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.00 / $7,572.00 / $18,942.00
| Facility | | $1,058.00 | $7,572.00 | $18,942.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.82 / $218.17 / $251.73
| Facility | | $167.82 | $218.17 | $251.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.81 / $761.00 / $2,513.90
| Facility | | $209.81 | $761.00 | $2,513.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,817.00 / $5,402.00
| Facility | | $900.00 | $3,817.00 | $5,402.00 |