- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.07 / $2,507.00 / $7,365.00
| Facility | | $429.07 | $2,507.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $1,451.00 / $3,553.00
| Facility | | $761.00 | $1,451.00 | $3,553.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,652.00 / $1,652.00 / $1,652.00
| Facility | | $1,652.00 | $1,652.00 | $1,652.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.90 / $414.60 / $1,216.00
| Facility | | $173.90 | $414.60 | $1,216.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.00 / $2,332.00 / $3,041.00
| Facility | | $1,380.00 | $2,332.00 | $3,041.00 |