- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $2,397.00 / $4,050.00
| Facility | | $739.00 | $2,397.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,690.44 / $9,682.37 / $14,106.04
| Facility | | $5,690.44 | $9,682.37 | $14,106.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.61 / $57.61 / $57.61
| Facility | | $57.61 | $57.61 | $57.61 |
- 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
- $1,141.00 / $4,717.00 / $11,696.00
| Facility | | $1,141.00 | $4,717.00 | $11,696.00 |