- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.00 / $2,447.00 / $5,150.00
| Facility | | $816.00 | $2,447.00 | $5,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,415.20 / $6,541.42 / $10,466.95
| Facility | | $3,415.20 | $6,541.42 | $10,466.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $594.59 / $2,807.66
| Facility | | $40.00 | $594.59 | $2,807.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $1,026.00 / $4,042.13
| Facility | | $725.00 | $1,026.00 | $4,042.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,661.00
| Facility | | $746.00 | $2,415.00 | $6,661.00 |