- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.96 / $4,376.00 / $12,600.00
| Facility | | $1,074.96 | $4,376.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.30 / $3,829.41 / $6,069.38
| Facility | | $2,597.30 | $3,829.41 | $6,069.38 |
- 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
- $687.89 / $1,074.96 / $11,642.00
| Facility | | $687.89 | $1,074.96 | $11,642.00 |
- 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 |