- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $623.00 / $2,258.00 / $6,681.00
| Facility | | $623.00 | $2,258.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,917.00 / $3,688.00 / $5,959.00
| Facility | | $1,917.00 | $3,688.00 | $5,959.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,622.48 / $1,746.72 / $16,394.00
| Facility | | $1,622.48 | $1,746.72 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.00 / $3,626.00 / $6,291.00
| Facility | | $1,794.00 | $3,626.00 | $6,291.00 |