- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.19 / $1,000.00 / $2,812.00
| Facility | | $129.19 | $1,000.00 | $2,812.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,886.47 / $1,886.47 / $2,263.76
| Facility | | $1,886.47 | $1,886.47 | $2,263.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.24 / $138.24 / $138.24
| Facility | | $138.24 | $138.24 | $138.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,349.57 / $2,349.57 / $2,349.57
| Facility | | $2,349.57 | $2,349.57 | $2,349.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.00 / $1,650.00 / $4,233.00
| Facility | | $980.00 | $1,650.00 | $4,233.00 |