- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.14 / $87.14 / $87.14
| Facility | | $87.14 | $87.14 | $87.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,728.33 / $2,273.23 / $4,397.14
| Facility | | $1,728.33 | $2,273.23 | $4,397.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.10 / $171.66 / $4,406.00
| Facility | | $111.10 | $171.66 | $4,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.61 / $212.80 / $246.35
| Facility | | $174.61 | $212.80 | $246.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |