- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $447.95 / $1,245.00 / $6,953.60
| Facility | | $447.95 | $1,245.00 | $6,953.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.47 / $522.47 / $522.47
| Facility | | $522.47 | $522.47 | $522.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $447.95 / $591.11 / $1,110.01
| Facility | | $447.95 | $591.11 | $1,110.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,629.00 / $9,541.00 / $14,589.00
| Facility | | $2,629.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,705.56 / $12,623.50
| Facility | | $55.00 | $1,705.56 | $12,623.50 |