- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $2,678.00 / $7,602.00
| Facility | | $1,100.00 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,174.00 / $3,927.00 / $6,090.00
| Facility | | $2,174.00 | $3,927.00 | $6,090.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,719.04 / $11,647.95 / $26,542.00
| Facility | | $2,719.04 | $11,647.95 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,722.00 / $7,669.00
| Facility | | $2,426.00 | $4,722.00 | $7,669.00 |