- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.39 / $2,397.00 / $4,050.00
| Facility | | $704.39 | $2,397.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,739.66 / $6,018.56 / $10,692.30
| Facility | | $2,739.66 | $6,018.56 | $10,692.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $529.57
| Facility | | $40.00 | $40.00 | $529.57 |
- 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
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |