- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.25 / $151.16 / $5,320.00
| Facility | | $104.25 | $151.16 | $5,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,215.00 / $2,292.00 / $4,229.00
| Facility | | $1,215.00 | $2,292.00 | $4,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.15 / $129.93 / $148.50
| Facility | | $92.15 | $129.93 | $148.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.48 / $170.77 / $1,117.44
| Facility | | $85.48 | $170.77 | $1,117.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.00 / $950.00 / $3,394.00
| Facility | | $391.00 | $950.00 | $3,394.00 |