- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.87 / $2,624.00 / $9,133.00
| Facility | | $545.87 | $2,624.00 | $9,133.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.60 / $796.92 / $1,322.90
| Facility | | $539.60 | $796.92 | $1,322.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.00 / $330.00 / $330.00
| Facility | | $330.00 | $330.00 | $330.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.20 / $564.55 / $2,463.00
| Facility | | $354.20 | $564.55 | $2,463.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.00 / $2,081.00 / $3,842.00
| Facility | | $825.00 | $2,081.00 | $3,842.00 |