- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.86 / $1,245.00 / $6,953.60
| Facility | | $116.86 | $1,245.00 | $6,953.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.12 / $498.00 / $606.10
| Facility | | $134.12 | $498.00 | $606.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.86 / $151.75 / $210.46
| Facility | | $116.86 | $151.75 | $210.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.00 / $661.00 / $4,824.00
| Facility | | $393.00 | $661.00 | $4,824.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $346.02 / $4,262.50
| Facility | | $55.00 | $346.02 | $4,262.50 |