- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.38 / $1,386.00 / $5,634.00
| Facility | | $111.38 | $1,386.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.00 / $3,840.00 / $7,036.00
| Facility | | $1,636.00 | $3,840.00 | $7,036.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.58 / $133.35 / $153.87
| Facility | | $102.58 | $133.35 | $153.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.11 / $402.00 / $655.97
| Facility | | $129.11 | $402.00 | $655.97 |
- 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 |