- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,397.00 / $4,509.00
| Facility | | $756.00 | $2,397.00 | $4,509.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,880.28 / $12,922.98 / $26,517.16
| Facility | | $6,880.28 | $12,922.98 | $26,517.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $861.65 / $11,054.74 / $11,054.74
| Facility | | $861.65 | $11,054.74 | $11,054.74 |
- 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
- $1,200.00 / $5,780.00 / $13,506.00
| Facility | | $1,200.00 | $5,780.00 | $13,506.00 |