- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $7,963.00
| Facility | | $1,965.00 | $4,521.00 | $7,963.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.70 / $5,094.77 / $8,070.83
| Facility | | $1,310.70 | $5,094.77 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.00 / $600.00 / $600.00
| Facility | | $600.00 | $600.00 | $600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $986.94 / $2,906.93 / $7,217.00
| Facility | | $986.94 | $2,906.93 | $7,217.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,856.00 / $4,545.00 / $7,217.00
| Facility | | $2,856.00 | $4,545.00 | $7,217.00 |