- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $919.85 / $2,758.00 / $5,432.00
| Facility | | $919.85 | $2,758.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,147.20 / $8,121.73 / $11,892.73
| Facility | | $4,147.20 | $8,121.73 | $11,892.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $645.09
| Facility | | $40.00 | $40.00 | $645.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.00 / $1,650.00 / $1,650.00
| Facility | | $1,650.00 | $1,650.00 | $1,650.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $11,696.00
| Facility | | $1,141.00 | $4,717.00 | $11,696.00 |