- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.35 / $4,230.00 / $9,727.00
| Facility | | $248.35 | $4,230.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,133.92 / $5,507.61 / $9,227.19
| Facility | | $2,133.92 | $5,507.61 | $9,227.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,221.33 / $1,221.33 / $1,569.43
| Facility | | $1,221.33 | $1,221.33 | $1,569.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.00 / $254.00 / $427.04
| Facility | | $190.00 | $254.00 | $427.04 |
- 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 |