- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,893.00 / $6,546.00
| Facility | | $762.00 | $1,893.00 | $6,546.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,685.25 / $9,663.12 / $13,753.10
| Facility | | $5,685.25 | $9,663.12 | $13,753.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.28 / $7,421.50 / $7,421.50
| Facility | | $696.28 | $7,421.50 | $7,421.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $1,200.00 / $1,200.00
| Facility | | $1,200.00 | $1,200.00 | $1,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $5,780.00 / $13,506.00
| Facility | | $1,200.00 | $5,780.00 | $13,506.00 |