- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,307.76 / $5,320.00
| Facility | | $787.00 | $1,307.76 | $5,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,289.81 / $5,830.00 / $11,253.00
| Facility | | $2,289.81 | $5,830.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.21 / $1,605.98 / $1,852.61
| Facility | | $1,110.21 | $1,605.98 | $1,852.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,405.09 / $1,405.09 / $1,405.09
| Facility | | $1,405.09 | $1,405.09 | $1,405.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.00 / $1,450.00 / $5,301.00
| Facility | | $523.00 | $1,450.00 | $5,301.00 |