- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $838.00 / $3,165.00 / $8,400.00
| Facility | | $838.00 | $3,165.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,075.78 / $3,306.56 / $5,279.47
| Facility | | $2,075.78 | $3,306.56 | $5,279.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.25 / $1,070.25 / $1,070.25
| Facility | | $1,070.25 | $1,070.25 | $1,070.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.94 / $386.28 / $5,477.56
| Facility | | $158.94 | $386.28 | $5,477.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,875.93 / $5,543.93
| Facility | | $884.00 | $2,875.93 | $5,543.93 |