- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.67 / $100.67 / $2,168.00
| Facility | | $100.67 | $100.67 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.56 / $1,087.84 / $2,457.60
| Facility | | $199.56 | $1,087.84 | $2,457.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.36 / $360.72 / $867.76
| Facility | | $254.36 | $360.72 | $867.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.78 / $329.78 / $683.28
| Facility | | $206.78 | $329.78 | $683.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.01 / $211.30 / $2,872.00
| Facility | | $162.01 | $211.30 | $2,872.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.00 / $2,872.00 / $4,241.00
| Facility | | $1,755.00 | $2,872.00 | $4,241.00 |