- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.20 / $1,300.00 / $3,500.00
| Facility | | $477.20 | $1,300.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.40 / $2,238.38 / $4,854.39
| Facility | | $1,174.40 | $2,238.38 | $4,854.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.00 / $451.00 / $451.00
| Facility | | $451.00 | $451.00 | $451.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.00 / $513.00 / $1,226.00
| Facility | | $194.00 | $513.00 | $1,226.00 |