- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.22 / $1,300.00 / $3,685.00
| Facility | | $467.22 | $1,300.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,810.80 / $7,146.54 / $9,685.89
| Facility | | $2,810.80 | $7,146.54 | $9,685.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $315.43
| Facility | | $40.00 | $40.00 | $315.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.00 / $543.00 / $1,560.00
| Facility | | $194.00 | $543.00 | $1,560.00 |