- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,261.00 / $4,635.72 / $12,600.00
| Facility | | $1,261.00 | $4,635.72 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.30 / $3,829.41 / $8,064.81
| Facility | | $2,597.30 | $3,829.41 | $8,064.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $505.00
| Facility | | $505.00 | $505.00 | $505.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $744.07 / $1,169.35 / $12,989.00
| Facility | | $744.07 | $1,169.35 | $12,989.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,407.00 / $12,989.00
| Facility | | $2,269.00 | $6,407.00 | $12,989.00 |