- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.00 / $2,397.00 / $4,509.00
| Facility | | $609.00 | $2,397.00 | $4,509.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,712.54 / $6,018.56 / $10,692.30
| Facility | | $2,712.54 | $6,018.56 | $10,692.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.10 / $3,111.43 / $3,111.43
| Facility | | $450.10 | $3,111.43 | $3,111.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,350.00 / $1,350.00
| Facility | | $1,350.00 | $1,350.00 | $1,350.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.00 / $2,785.00 / $7,984.00
| Facility | | $826.00 | $2,785.00 | $7,984.00 |