- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.47 / $3,776.00 / $9,727.00
| Facility | | $117.47 | $3,776.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,769.76 / $4,543.77 / $7,996.46
| Facility | | $1,769.76 | $4,543.77 | $7,996.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,221.33 / $1,569.43
| Facility | | $375.00 | $1,221.33 | $1,569.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.18 / $158.00 / $238.18
| Facility | | $94.18 | $158.00 | $238.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |