- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,326.25 / $2,747.00
| Facility | | $787.00 | $1,326.25 | $2,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.00 / $3,498.00 / $8,517.00
| Facility | | $1,643.00 | $3,498.00 | $8,517.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $955.52 / $1,376.45 / $1,587.83
| Facility | | $955.52 | $1,376.45 | $1,587.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,203.74 / $1,203.74 / $1,203.74
| Facility | | $1,203.74 | $1,203.74 | $1,203.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $2,723.00 / $6,295.00
| Facility | | $599.00 | $2,723.00 | $6,295.00 |