- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.07 / $2,212.00 / $4,050.00
| Facility | | $537.07 | $2,212.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,340.63 / $4,915.07 / $6,903.94
| Facility | | $1,340.63 | $4,915.07 | $6,903.94 |
- 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
- $848.00 / $848.00 / $848.00
| Facility | | $848.00 | $848.00 | $848.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.00 / $513.00 / $1,226.00
| Facility | | $194.00 | $513.00 | $1,226.00 |