- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $1,520.00 / $3,685.00
| Facility | | $580.00 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,712.54 / $4,838.85 / $6,815.16
| Facility | | $2,712.54 | $4,838.85 | $6,815.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $552.74
| Facility | | $40.00 | $40.00 | $552.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.00 / $2,918.00 / $7,738.10
| Facility | | $826.00 | $2,918.00 | $7,738.10 |