- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.73 / $4,375.00 / $16,467.00
| Facility | | $322.73 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,175.92 / $4,428.83 / $7,666.70
| Facility | | $2,175.92 | $4,428.83 | $7,666.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $375.00 / $1,677.54
| Facility | | $375.00 | $375.00 | $1,677.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.77 / $322.73 / $477.69
| Facility | | $247.77 | $322.73 | $477.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $10,257.00 / $16,249.00
| Facility | | $1,258.00 | $10,257.00 | $16,249.00 |