- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,448.00 / $5,432.00
| Facility | | $860.00 | $2,448.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,767.68 / $8,007.57 / $13,982.44
| Facility | | $4,767.68 | $8,007.57 | $13,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $742.53
| Facility | | $40.00 | $40.00 | $742.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,913.00 / $11,696.00
| Facility | | $1,141.00 | $4,913.00 | $11,696.00 |