- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.16 / $505.01 / $1,400.00
| Facility | | $79.16 | $505.01 | $1,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.66 / $97.38 / $106.10
| Facility | | $87.66 | $97.38 | $106.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.56 / $140.56 / $140.56
| Facility | | $140.56 | $140.56 | $140.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,525.54 / $3,525.54 / $3,525.54
| Facility | | $3,525.54 | $3,525.54 | $3,525.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,743.33 / $5,743.33 / $5,743.33
| Facility | | $5,743.33 | $5,743.33 | $5,743.33 |